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Kiskaddon AL, Smith MM, Gilliland F, Rech MA. Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study. Crit Care Explor 2023; 5:e0980. [PMID: 37811129 PMCID: PMC10558220 DOI: 10.1097/cce.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES To comprehensively classify interventions performed by pediatric critical care clinical pharmacists and quantify cost avoidance (CA) generated through their accepted interventions. DESIGN A multicenter, prospective, observational study performed between August 2018 and January 2019. SETTING Academic and community hospitals in the United States with pediatric critical care units. SUBJECTS Pediatric clinical pharmacists. INTERVENTIONS Pharmacist recommendations were classified into one of 38 total intervention categories associated with CA. MEASUREMENTS AND MAIN RESULTS Nineteen pediatric pharmacists at five centers documented 1,458 accepted interventions during 112 shifts on 861 critically ill pediatric patients. This calculated to an associated CA of $450,590. The accepted interventions and associated CA in the six established categories included as follows: adverse drug event prevention (155 interventions, $118,901 CA), resource utilization (267 interventions; $59,020), individualization of patient care (898 interventions, $217,949 CA), prophylaxis (8 interventions, $453 CA), hands-on care (30 interventions, $35,509 CA), and administrative/supportive tasks (108 interventions, $18,758 CA). The average associated CA was $309 per accepted intervention, $523 per patient day, and $4,023.13 per pediatric clinical pharmacist shift. The calculated potential annualized CA of accepted interventions from a pediatric pharmacist was $965,550, resulting in a potential monetary-associated CA-to-pharmacist salary ratio between $1.5:1 and $5.2:1. CONCLUSIONS There is potential for significant avoidance of healthcare costs when pediatric pharmacists are involved in the care of critically and emergently ill pediatric patients, with a monetary potential CA-to-pediatric pharmacist salary ratio to be between $1.5:1 and $5.2:1.
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Affiliation(s)
- Amy L Kiskaddon
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, FL
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michelle M Smith
- Division of Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Frankie Gilliland
- Division of Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Megan A Rech
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
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2
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Grant JJ, McDade EJ, Zobell JT, Young DC. The indispensable role of pharmacy services and medication therapy management in cystic fibrosis. Pediatr Pulmonol 2022; 57 Suppl 1:S17-S39. [PMID: 34347382 DOI: 10.1002/ppul.25613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/24/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
Care for people with cystic fibrosis (PWCF) is highly complex and requires a multidisciplinary approach where the pharmacist plays a vital role. The purpose of this manuscript is to serve as a guideline for pharmacists and pharmacy technicians who provide care for PWCF by providing background and current recommendations for the use of cystic fibrosis (CF)-specific medications in both the acute and ambulatory care settings. The article explores current literature surrounding the role of pharmacists and pharmacy technicians, proven pharmacy models to emulate, and pharmacokinetic idiosyncrasies unique to the CF population while also identifying areas of future research. Clinical recommendations for the use of CF-specific medications are broken down by organ system including mechanism of action, adverse events, dosages, and monitoring parameters. The article also includes quick reference tables essential to the acute and chronic medication therapy management of PWCF.
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Affiliation(s)
- Jonathan J Grant
- Department of Outpatient Pharmacy-Specialty Services, The John's Hopkins Hospital, Baltimore, Maryland, USA
| | - Erin J McDade
- Pharmacy Department, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffery T Zobell
- Pharmacy Department, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA
| | - David C Young
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
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3
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Soliman ABE, Pawluk SA, Wilby KJ, Rachid O. The use of a modified Delphi technique to develop a critical appraisal tool for clinical pharmacokinetic studies. Int J Clin Pharm 2022; 44:894-903. [PMID: 35307788 PMCID: PMC9393138 DOI: 10.1007/s11096-022-01390-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Critical appraisal aids in assessing the quality of scientific literature, which is central to the practice of evidence-based medicine. Several tools and guidelines are available for critiquing and assessing the quality of specific study types. However, limited guidance exists for critical appraisal of clinical pharmacokinetic studies. AIM We aimed to achieve experts' consensus regarding the quality markers for clinical pharmacokinetic studies in an attempt to develop a critical appraisal tool. METHOD Quality markers related to clinical pharmacokinetic studies, were derived from the published literature and categorized according to manuscript reporting domains (abstract, introduction/background, methodology, results, discussion, and conclusion). Questions that aid in appraising pharmacokinetic studies were formulated from these quality markers. Experts were involved in a modified Delphi process to achieve a consensus regarding the formulated questions. The proposed tool was pilot tested on 30 recently published clinical pharmacokinetic studies. Inter-observer agreement was measured to determine the reliability of the included items. RESULTS Twenty-five experts consented to participate. Three rounds of a modified Delphi survey were required to generate a consensus for a 21-item tool aimed at appraising the quality of clinical pharmacokinetic studies. When applied to 30 recently published clinical pharmacokinetic studies, most items scored fair to moderate levels of agreement (61.90-95.24%). CONCLUSION The clinical pharmacokinetic critical appraisal tool (CACPK) developed in this study consisted of 21 items aimed at helping an end-user to determine the quality of a pharmacokinetic study. Further studies are warranted to reaffirm the validity and reliability of the CACPK tool.
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Affiliation(s)
| | - Shane Ashley Pawluk
- Children’s & Women’s Health Centre of British Columbia, Provincial Health Services Authority, British Columbia, Canada ,Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia Canada
| | - Ousama Rachid
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar. .,Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar. .,Correspondence: College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
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4
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Saadah LM, Khan AH, Syed Sulaiman SA, Bashiti IA. Maximizing acceptance of clinical pharmacy recommendations to reduce length of hospital stay in a private hospital from Amman, Jordan. BMC Health Serv Res 2021; 21:937. [PMID: 34496856 PMCID: PMC8424814 DOI: 10.1186/s12913-021-06966-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Clinical pharmacy interventions (CPI) usually require prior medical authorization. Physicians approve 80% of CPI and reject 20%. If pharmacists show that physicians should authorize all 100% CPI, the profession will step closer to a fully independent prescriber status. This study used an artificial neural network (ANN) model to determine whether clinical pharmacy (CP) may improve outcomes associated with rejected CPI. Method This is a non-interventional, retrospective analysis of documented CPI in a 100-bed, acute-care private hospital in Amman, Jordan. Study consisted of 542 patients, 574 admissions, and 1694 CPI. Team collected demographic and clinical data using a standardized tool. Input consisted of 54 variables with some taking merely repetitive values for each CPI in each patient whereas others varying with every CPI. Therefore, CPI was consolidated to one rejected and/or one accepted per patient per admission. Groups of accepted and rejected CPI were compared in terms of matched and unmatched variables. ANN were, subsequently, trained and internally as well as cross validated for outcomes of interest. Outcomes were length of hospital and intensive care stay after the index CPI (LOSTA & LOSICUA, respectively), readmissions, mortality, and cost of hospitalization. Best models were finally used to compare the two scenarios of approving 80% versus 100% of CPI. Variable impacts (VI) automatically generated by the ANN were compared to evaluate the effect of rejecting CPI. Main outcome measure was Lengths of hospital stay after the index CPI (LOSTA). Results ANN configurations converged within 18 s and 300 trials. All models showed a significant reduction in LOSTA with 100% versus 80% accepted CPI of about 0.4 days (2.6 ± 3.4, median (range) of 2 (0–28) versus 3.0 ± 3.8, 2 (0–30), P-value = 0.022). Average savings with acceptance of those rejected CPI was 55 JD (~ 78 US dollars) and could help hire about 1.3 extra clinical pharmacist full-time equivalents. Conclusions Maximizing acceptance of CPI reduced the length of hospital stay in this model. Practicing Clinical Pharmacists may qualify for further privileges including promotion to a fully independent prescriber status.
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Affiliation(s)
- Loai M Saadah
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia. .,Department of Clinical Pharmacy, Ibn Al Haytham Hospital, Amman, Hashemite Kingdom of Jordan. .,Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences University Pharmacy, 11931, Amman, Hashemite Kingdom of Jordan.
| | - Amer H Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Iman A Bashiti
- Department of Clinical Pharmacy, Ibn Al Haytham Hospital, Amman, Hashemite Kingdom of Jordan.,Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences University Pharmacy, 11931, Amman, Hashemite Kingdom of Jordan
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5
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Maffre I, Leguelinel-Blache G, Soulairol I. A systematic review of clinical pharmacy services in pediatric inpatients. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Zobell JT, Moss J, Heuser S, Roe L, Young DC. Understanding the expanding role of pharmacy services in outpatient cystic fibrosis care. Pediatr Pulmonol 2021; 56:1378-1385. [PMID: 33470556 DOI: 10.1002/ppul.25283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/02/2021] [Accepted: 01/15/2021] [Indexed: 11/11/2022]
Abstract
Cystic fibrosis (CF) patients utilize an average of 10 (±5) medications per day. Given the complexity of the medication regimen, the CF Foundation (CFF) recommends pharmacists as members of the CF care team. The areas of pharmacy services have been identified in the literature. "Limited access pharmacists" are consulted to answer questions, assist in evaluating serum drug concentrations, provide medication education, and monitor for drug-drug interactions. Reduction in hospital length of stay has been shown through this collaboration. "Full access pharmacists" provide comprehensive medication therapy management resulting in medication adherence and access improvements, sustainability of treatments, improved provider communication, reduced medication errors and costs, expedited medication refill authorization, increased utilization of respiratory therapists, enhanced discussion of medications with CF team members, and reduction in the number of pharmacies utilized by patients to fill CF medications. An integrated CF pharmacy team are essential members of the multidisciplinary CF care team that have been shown to improve in CF medication access, increases in body weight and body mass index, reduction in prior authorization submission times, reduction in medication delivery times, expedited medication refill authorizations, increased collaboration with respiratory therapists, augmented discussion of medication with CF team members, and reduction in the number of pharmacies utilized by CF patients. There is a need to further evaluate the impact of outpatient CF pharmacy services due to the improvements in the care on patients and families affected by CF, and as the number of CFF-accredited care centers integrates CF pharmacy teams throughout the country increases.
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Affiliation(s)
- Jeffery T Zobell
- Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.,Department of Pharmacy, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA
| | - Justin Moss
- Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.,Department of Pharmacy, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA
| | - Stephanie Heuser
- Department of Pharmacy, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA.,Department of Pharmacy, Intermountain Specialty Pharmacy, Taylorsville, Utah, USA
| | - Lynda Roe
- Department of Pharmacy, University of Utah Adult Cystic Fibrosis Center, Salt Lake City, Utah, USA
| | - David C Young
- Department of Pharmacy, University of Utah Adult Cystic Fibrosis Center, Salt Lake City, Utah, USA.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
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7
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Le T, Lord L, Pignataro S, Simioni D, Cheah R. Evaluating the Impact of Education on Pharmacist Tobramycin Dose Recommendations for Cystic Fibrosis and a Review of Perceptions on Pharmacist-Led Charting. J Pharm Pract 2021; 35:903-910. [PMID: 34013814 DOI: 10.1177/08971900211018419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pharmacists routinely interpret and optimize tobramycin dosing for people with cystic fibrosis (PwCF). OBJECTIVES To determine the impact of tobramycin therapeutic drug monitoring (TDM) education on pharmacist dose recommendations, and to explore nurses' and medical doctors' perceptions toward pharmacist-led TDM charting. METHODS This study involved 3 phases: a 12-month retrospective audit of PwCF prescribed tobramycin to identify the appropriateness of pharmacists' dose recommendations, a pharmacist tobramycin educational intervention utilizing a voiceover presentation with pre- and post-online tobramycin TDM assessment (involving multiple choice pharmacokinetics and case-based scenario questions), and a cross-sectional survey of respiratory nurses' and doctors' perceptions toward pharmacist-led TDM charting. The pharmacists' dose recommendations, in the audit and case-based questions, were considered appropriate if subsequent levels achieved the targeted area under the curve (AUC). RESULTS Audit results revealed that 44.4% of the 277 pharmacist dose recommendations identified were appropriate. The pre- and post-interventional assessments were completed by 51 and 52 pharmacists, respectively. Post intervention, correct scores were significantly higher than pre-intervention, evident in both the pharmacokinetics (median score 75% vs 100%; P = 0.048) and case-based scenario (median score 60% vs 90%; P < 0.0001) questions. Of the 54 nurses and medical doctors surveyed, 92.6% supported the implementation of pharmacist-led tobramycin charting. CONCLUSION The study demonstrated an increased accuracy and appropriateness of pharmacists' tobramycin pharmacokinetics knowledge and TDM dose recommendations post-educational intervention and highlighted nurses' and medical doctors' support of pharmacist-led tobramycin TDM charting.
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Affiliation(s)
- Tran Le
- Pharmacy Department, Monash Health, Melbourne, Victoria, Australia
| | - Louise Lord
- Pharmacy Department, Monash Health, Melbourne, Victoria, Australia
| | | | - Diana Simioni
- Pharmacy Department, Monash Health, Melbourne, Victoria, Australia
| | - Ron Cheah
- Pharmacy Department, Monash Health, Melbourne, Victoria, Australia.,National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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8
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Carland JE, Stocker SL, Baysari MT, Li C, Själin J, Moran MA, Tang S, Sandaradura I, Elhage T, Gilbey T, Williams KM, Marriott DJE, Day RO. Are vancomycin dosing guidelines followed? A mixed methods study of vancomycin prescribing practices. Br J Clin Pharmacol 2021; 87:4221-4229. [PMID: 33769612 DOI: 10.1111/bcp.14834] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Despite the availability of international consensus guidelines, vancomycin dosing and therapeutic drug monitoring (TDM) remain suboptimal. This study aimed to assess concordance of vancomycin dosing and TDM with institutional guidelines and to identify factors taken into consideration by clinicians when prescribing vancomycin. METHODS A retrospective audit of 163 patients receiving vancomycin therapy (≥48 hours) was undertaken. Data collected included patient characteristics, dosing history and plasma vancomycin and creatinine concentrations. Concordance of dosing and TDM with institutional guidelines was evaluated. Semi-structured interviews, including simulated prescribing scenarios, were undertaken with prescribers (n = 17) and transcripts analysed. RESULTS Plasma vancomycin concentrations (n = 1043) were collected during 179 courses of therapy. Only 24% of courses commenced with a loading dose with 72% lower than recommended. The initial maintenance dose was concordant in 42% of courses with 34% lower than recommended. Only 14% of TDM samples were trough vancomycin concentrations. Dose was not adjusted for 60% (21/35) of subtherapeutic and 43% (18/42) of supratherapeutic trough vancomycin concentrations, respectively. Interview participants reported that patient characteristics (including renal function), vancomycin concentrations, guidelines and expert advice influenced vancomycin prescribing decisions. Despite referring to guidelines when completing simulated prescribing scenarios, only 37% of prescribing decisions aligned with guideline recommendations. CONCLUSION Poor compliance with institutional vancomycin guidelines was observed, despite prescriber awareness of available guidelines. Multifaceted strategies to support prescriber decision-making are required to improve vancomycin dosing and monitoring.
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Affiliation(s)
- Jane E Carland
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,Department of Pharmacology, School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Sophie L Stocker
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Melissa T Baysari
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Crystal Li
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Jacqueline Själin
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Maria A Moran
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Sarah Tang
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Pharmacy Department, Singapore General Hospital, Singapore, Singapore
| | - Indy Sandaradura
- Centre for Infectious Diseases and Clinical Microbiology, Westmead Hospital, Westmead, NSW, Australia.,Sydney School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Tania Elhage
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Timothy Gilbey
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Kenneth M Williams
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,School of Medical Sciences, University of NSW, Kensington, NSW, Australia
| | - Deborah J E Marriott
- St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.,Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia
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9
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Huang SP, McKinzie CJ, Tak CR. Cost-effectiveness of implementing routine hearing screening using a tablet audiometer for pediatric cystic fibrosis patients receiving high-dose IV aminoglycosides. J Manag Care Spec Pharm 2021; 27:157-165. [PMID: 33506732 PMCID: PMC10390962 DOI: 10.18553/jmcp.2021.27.2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Cystic fibrosis (CF) patients who receive high-dose aminoglycosides can acquire inner ear damage and subsequent hearing loss. There is no current standard protocol for assessing ototoxicity in CF centers in the United States. OBJECTIVE: To evaluate the cost-effectiveness of a pharmacist-implemented routine hearing screening for ototoxicity among pediatric patients using a clinically validated tablet audiometer to allow for earlier detection of hearing loss in an exploratory analysis. METHODS: A Markov decision-analytic model was developed to assess the cost-effectiveness of implementing routine screening with monthly cycles over a 3-year time horizon. The model measured the difference in promptly detected hearing loss, delayed detected hearing loss, and undetected hearing loss, compared with current screening practices. Model inputs were obtained through a comprehensive literature review. Primary model outcomes included total health care costs and quality-adjusted life-years (QALYs) gained with a 3% yearly discount. One-way, two-way, and probabilistic sensitivity analyses were conducted to evaluate model uncertainty. RESULTS: In a hypothetical cohort of 100 patients, routine screening using a tablet audiometer increased promptly detected hearing loss by 8 patients. There was an incremental gain of 3.2 QALYs at an increased cost of $333,826 compared with current screening practices. This resulted in an incremental cost-effectiveness ratio (ICER) of $103,771 per QALY. In the 1-way sensitivity analysis, the ICER ranged between $64,345 and $258,830 per QALY. CONCLUSIONS: Using a tablet audiometer for routine hearing screening appears to be a cost-effective option at a $150,000 per QALY willingness-to-pay threshold when only considering the immediate benefits gained. This analysis did not examine the long-term effects of early detection in language development for pediatric patients. DISCLOSURES: Huang reports funding from the University of North Carolina and GlaxoSmithKline Health Outcomes Fellowship. GlaxoSmithKline had no involvement in the study creation, analysis, or manuscript composition. The other authors have nothing to disclose.
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Affiliation(s)
- Shirley P Huang
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill
| | | | - Casey R Tak
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill and University of North Carolina Health Sciences at MAHEC, Asheville
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10
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Zobell JT, Moss J, Heuser SM, Asfour F. Impact of pharmacy technicians as part of an integrated health-system pharmacy team on improvement of medication access in the care of cystic fibrosis patients. Pediatr Pulmonol 2020; 55:3351-3357. [PMID: 32876997 DOI: 10.1002/ppul.25050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic disease requiring patients to take multiple medications per day. Multiple barriers exist affecting access and adherence. Studies have demonstrated the positive outcomes of pharmacist involvement in CF care. The purpose of this study is to characterize the impact of pharmacy technicians on medication access in the care of CF patients. METHODS A retrospective review and analysis of patient medication profiles for patients followed by the integrated pharmacy care process model was performed. Two electronic prescription pathways with pharmacy technician involvement were analyzed. One pathway using a specialty pharmacy CF pharmacy technician (SP technician) examined CF specialty medication delivery times. The other pathway examined the impact of the clinic-based CF pharmacy technician (CB technician) on the number of filling pharmacies for patients. RESULTS One-hundred and fifty-three patients met inclusion criteria in the CF specialty medication delivery analysis, and 56 patients met inclusion criteria filling pharmacy analysis. The median delivery time for dornase alfa decreased from 8 days to 3 days, p < .00001. The number of patients utilizing one filling pharmacy increased from 8 (14%) to 21 (38%) (p = .005); and utilizing three filling pharmacies decreased from 14 (25%) to 1 (2%) (p = .003). CONCLUSION The study demonstrated that pharmacy technicians as part of an integrated health-system pharmacy care process model improve medication access in the care of CF patients.
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Affiliation(s)
- Jeffery T Zobell
- Pharmacy Department, Intermountain Primary Children, Salt Lake City, Utah, USA.,Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA
| | - Justin Moss
- Pharmacy Department, Intermountain Primary Children, Salt Lake City, Utah, USA.,Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA
| | - Stephanie M Heuser
- Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA.,Pharmacy Department, Intermountain Specialty Pharmacy, Taylorsville, Utah, USA
| | - Fadi Asfour
- Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA.,Pediatric Pulmonology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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11
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Almohammde S, Alhodian H, Almofareh S, Alshehri S, Almasri DM, Ghoneim RH. A survey of therapeutic drug monitoring in a teaching hospital. Saudi J Biol Sci 2020; 28:744-747. [PMID: 33424362 PMCID: PMC7783832 DOI: 10.1016/j.sjbs.2020.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/24/2020] [Accepted: 11/01/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Therapeutic drug monitoring (TDM) is one of the tools that aim to improve and ensure the best therapeutic effects while avoiding drug toxicity. This study aimed to identify the clinical utilization and application of TDM at a major teaching hospital in Jeddah. Methods A cross sectional survey of the clinical utilization and application of TDM at King Abdulaziz University Teaching Hospital across nurses in medical, surgical, pediatric, and intensive care units. The sample size (n = 130) represented 30% of the nursing population. The collection of questionnaires started on the 31st of January 2019 and was completed by the 10th of March 2019. Results The indication to use TDM was well-known to respondents. However, only 64% of respondents reported collection and measuring of the correct drug levels at a precise sampling time with no specific protocols being followed for each drug. Moreover, only 53% reported that the drug levels were being re-measured and adequately monitored for the right indication and proper sampling time. Regarding the presence of clinical pharmacists, 70% of the respondents indicated that no clinical pharmacist worked in their department. Conclusion Results demonstrate that appropriate sampling time was not used for the majority of monitored drugs. In the absence of a TDM request form, this finding probably indicates the lack of national or local TDM guidelines. In conclusion, TDM services, which include standardized forms, references, and an active clinical pharmacist will likely improve the application of TDM.
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Affiliation(s)
- Shahad Almohammde
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hadil Alhodian
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Almofareh
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samah Alshehri
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Diena M Almasri
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ragia H Ghoneim
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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12
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Lin G, Huang R, Zhang J, Li G, Chen L, Xi X. Clinical and economic outcomes of hospital pharmaceutical care: a systematic review and meta-analysis. BMC Health Serv Res 2020; 20:487. [PMID: 32487066 PMCID: PMC7268541 DOI: 10.1186/s12913-020-05346-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/20/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hospital clinical pharmacists have been working in many countries for many years and clinical pharmaceutical care have a positive effect on the recovery of patients. In order to evaluate the clinical effectiveness and economic outcomes of clinical pharmaceutical care, relevant clinical trial studies were reviewed and analysed. METHODS Two researchers searched literatures published from January 1992 to October 2019, and screened them by keywords like pharmaceutical care, pharmaceutical services, pharmacist interventions, outcomes, effects, impact, etc. Then, duplicate literatures were removed and the titles, abstracts and texts were read to screen literatures according to inclusion and exclusion criteria. Key data in the literature were extracted, and Meta-analysis was conducted using the literature with common outcome indicators. RESULTS A total of 3299 articles were retrieved, and 42 studies were finally included. Twelve of them were used for meta-analysis. Among the 42 studies included, the main results of pharmaceutical care showed positive effects, 36 experimental groups were significantly better than the control group, and the remaining 6 studies showed mixed or no effects. Meta-analysis showed that clinical pharmacists had significant effects on reducing systolic blood pressure and diastolic blood pressure and shortening hospitalization days (P < 0.05), but no statistical significance in reducing medical costs (P > 0.05). CONCLUSION Clinical pharmacists' pharmaceutical care has a significant positive effect on patients' clinical effects, but has no significant economic effect.
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Affiliation(s)
- Guohua Lin
- China Pharmaceutical University, Nanjing, China
| | - Rong Huang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Jing Zhang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Gaojie Li
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Lei Chen
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China.
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LaRochelle JM, Smith KP, Benavides S, Bobo K, Chung AM, Farrington E, Kennedy A, Knoppert D, Lee B, Manasco KB, Pettit R, Phan H, Potts AL, Sandritter T, Hagemann T. Evidence demonstrating the pharmacist's direct impact on clinical outcomes in pediatric patients: An opinion of the pediatrics practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph M. LaRochelle
- Xavier University of Louisiana College of Pharmacy and Louisiana State University School of Medicine New Orleans Louisiana
| | - Katherine P. Smith
- College of Pharmacy Roseman University of Health Sciences South Jordan Utah
| | | | - Kelly Bobo
- Le Bonheur Children's Hospital Memphis Tennessee
| | | | | | | | | | - Bernard Lee
- Mease Countryside Hospital, BayCare Health Safety Harbor Florida
| | | | - Rebecca Pettit
- Riley Hospital for Children Indiana University Health Indianapolis Indiana
| | - Hanna Phan
- The University of Arizona—Colleges of Pharmacy and Medicine Tucson Arizona
| | - Amy L. Potts
- Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville Tennessee
| | | | - Tracy Hagemann
- College of Pharmacy University of Tennessee Nashville Tennessee
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14
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Talon B, Perez A, Yan C, Alobaidi A, Zhang KH, Schultz BG, Suda KJ, Touchette DR. Economic evaluations of clinical pharmacy services in the United States: 2011-2017. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Brian Talon
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Alexandra Perez
- Department of Sociobehavioral and Administrative Pharmacy; Nova Southeastern University; Fort Lauderdale Florida
| | - Connie Yan
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Ali Alobaidi
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Katherine H. Zhang
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Bob G. Schultz
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
| | - Katie J. Suda
- Department of Medicine, Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Daniel R. Touchette
- Department of Pharmacy Systems, Outcomes & Policy; University of Illinois at Chicago; Chicago Illinois
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15
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Webster S, Kane C, Brown C, Warhurst H, Sedgley S, Slaughter W. Pediatric Pharmacy Services: Current Models and Justification for Expansion. J Pediatr Pharmacol Ther 2019; 24:438-444. [PMID: 31598108 DOI: 10.5863/1551-6776-24.5.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite recommendations from numerous health care bodies, some hospitals that care for children have struggled to establish or expand pediatric pharmacy services. The current state of dedicated pediatric operational and clinical pharmacy services was characterized by results from a survey of hospitals that provide care to pediatric patients. The discussion of quality of care, safety, and financial impact is meant to provide concepts for justification of pediatric pharmacy service expansion.
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16
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Young DC, Autry E, Zobell JT, Kormelink L, Homa K, Sabadosa KA, Kanga J, Anstead M, Kuhn R. Patients and families experience with pharmacist care at cystic fibrosis foundation accredited clinics. Pediatr Pulmonol 2019; 54:1216-1224. [PMID: 31066229 DOI: 10.1002/ppul.24348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 11/06/2022]
Abstract
Cystic fibrosis (CF) is a complex genetic, multiorgan disease. The CF Foundation (CFF) recommends a multidisciplinary team (physician, nurse, respiratory therapist, dietitian, physical therapist, social worker, mental health coordinator, clinic coordinator, and pharmacist) to work with patients and families. The objective of our study was to describe the impact of a pharmacist involved in the care of patients and families from their perspective. The CF Patient and Family Experience of Care (PFEC) is a voluntary, 50-question telephonic or internet-based survey designed to continuously collect information from patients and their families regarding their care experience. From August of 2017 through February of 2018, five questions were added to the internet survey to assess the impact of the pharmacist on the care experience. From the 666 respondents, 54% reported that a pharmacist was involved in their CF care. At two CF clinics designated as "full access" to a pharmacist, respondents reported a higher percentage of the CF-team discussed medications compared to those from three clinics designated as "limited access" to the pharmacist (95% vs 67%). Respondents in clinics with "full access" to a pharmacist were significantly more likely to get their medications refilled on time (78% vs 63%) and reported using fewer pharmacies to fill their medications. Pharmacist involvement in CF care may improve patient's access to medication and the ability to sustain use.
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Affiliation(s)
- David C Young
- University of Utah Adult Cystic Fibrosis Center, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Elizabeth Autry
- University of Kentucky HealthCare Pharmacy Services, Lexington, Kentucky.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Jeffery T Zobell
- Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah
| | - Lauren Kormelink
- University of Kentucky HealthCare Pharmacy Services, Lexington, Kentucky
| | - Karen Homa
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Kathryn A Sabadosa
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
| | - Jamshed Kanga
- Department of Pediatric Pulmonary Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Michael Anstead
- Department of Pediatric Pulmonary Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Robert Kuhn
- University of Kentucky HealthCare Pharmacy Services, Lexington, Kentucky.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
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17
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Brown SW, Oliveri LM, Ohler KH, Briars L. Identification of Errors in Pediatric Prescriptions and Interventions to Prevent Errors: A Survey of Community Pharmacists. J Pediatr Pharmacol Ther 2019; 24:304-311. [PMID: 31337993 DOI: 10.5863/1551-6776-24.4.304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Assess the competency of community pharmacists in identifying errors in pediatric prescriptions and to determine how often pharmacists perform interventions known to mitigate the likelihood of error. The study sought to recognize factors that may impact the pharmacist's ability to identify and mediate these errors, and to detect barriers that limit the role of the pharmacist pediatric patient care. METHODS A survey was distributed through the University of Illinois at Chicago College of Pharmacy Alumni Network and the Illinois Pharmacists Association email listservs. Pharmacists practicing in a retail setting within the last 5 years were included. Three prescription scenarios for commonly used pediatric medications with corresponding questions were created to assess a pharmacist's ability to identify errors. Demographics pertaining to the pharmacist and the practice site, as well as information about dispensing practices, were collected. Logistic regression was used to identify factors that might impact the pharmacists' ability to identify errors. RESULTS One hundred sixty-one respondents began the survey and 138 met inclusion criteria. In 15% to 59% of scenario-based questions, pharmacists did not appropriately identify errors or interventions that would decrease the likelihood of error. Correct identification of doses was associated with total prescription volume in one scenario and with pediatric prescription volume in another scenario. Pharmacists did not consistently label prescriptions for oral liquids in milliliters or dispense oral syringes. Barriers to pharmacist involvement included availability and interest of the caregiver, ability to contact prescriber, and pharmacy staffing. CONCLUSION Community pharmacists did not consistently identify medication errors or use interventions known to mitigate error risk.
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18
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Abraham O, Morris A. Opportunities for Outpatient Pharmacy Services for Patients with Cystic Fibrosis: Perceptions of Healthcare Team Members. PHARMACY 2019; 7:pharmacy7020034. [PMID: 30987260 PMCID: PMC6631244 DOI: 10.3390/pharmacy7020034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 11/16/2022] Open
Abstract
Cystic fibrosis (CF) is one of the most common life-threatening, genetic conditions. People with CF follow complex, time-consuming treatment regimens to manage their chronic condition. Due to the complexity of the disease, multidisciplinary care from CF Foundation (CFF)-accredited centers is recommended for people with CF. These centers include several types of healthcare professionals specializing in CF; however, pharmacists are not required members. The purpose of this study was to identify the outpatient care needs of people living with CF that pharmacists could address to improve their quality of care. Healthcare members from a CFF accredited center and pharmacists were recruited to participate in semi-structured, audio-recorded interviews. Prevalent codes were identified and data analysis was conducted, guided by the systems engineering initiative for patient safety (SEIPS) model. The objective was to understand the medication and pharmacy-related needs of patients with CF and care team perspectives on pharmacists providing support for these patients. From the themes that emerged, pharmacists can provide support for people living with CF (medication burden, medication access, medication education) and the CF care team (drug monitoring and adherence, prior authorizations and insurance coverage, refill history). Pharmacists are well-positioned to address these difficulties to improve quality of care for people living with cystic fibrosis.
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Affiliation(s)
- Olufunmilola Abraham
- Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, WI 53705, USA.
| | - Ashley Morris
- Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, WI 53705, USA.
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19
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Coulthard KP. Cystic fibrosis: novel therapies, remaining challenges. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kingsley P. Coulthard
- School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
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20
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Abraham O, Li JS, Monangai KE, Feathers AM, Weiner D. The pharmacist's role in supporting people living with cystic fibrosis. J Am Pharm Assoc (2003) 2018; 58:246-249. [PMID: 29459095 DOI: 10.1016/j.japh.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the critical need for pharmacists' involvement in outpatient care for people living with cystic fibrosis (CF). DATA SOURCES Not applicable. SUMMARY CF is a pulmonary condition that affects more than 30,000 children and adults in the United States and 70,000 people worldwide. Various complex medication regimens are given to patients with CF, some depending on the type of mutation they have in their CF transmembrane conductance regulator protein. With complex medication regimens and the increased number and variety of treatments that have become available, the medication use burden intensifies for individuals living with CF and their caregivers. Young people living with CF have a particularly difficult time adhering to medications and other therapies as they begin to rely less on their caregivers and assume greater medication management responsibility for their care. Adolescents report low adherence rates from about 40% to 47% for airway clearance methods and even lower for nutritional recommendations, about 16% to 20%. In inpatient settings, pharmacists have been successful in making medication use recommendations that have improved adherence for patients with CF while in the hospital. However, limited research has explored how provision of pharmacist supportive care and patient education in outpatient settings can improve medication adherence and quality of life for people living with CF. CONCLUSION There is potential for provision of outpatient pharmacy clinical services to increase medication adherence and overall quality of care for patients with CF. Higher rates of medication adherence in patients with CF could in turn improve patient outcomes and reduce overall health care costs as a result of fewer rehospitalizations. Pharmacies can implement programs designed to provide comprehensive support services and medication management from pharmacists and staff that are trained in CF care.
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21
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Farrington E. Moving the profession forward. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Elizabeth Farrington
- Pediatric Specialty Council, Board of Pharmacy Specialties; Pharmacist III - Pediatrics, Department of Pharmacy; New Hanover Regional Medical Center; 2131 S. 17th Street P.O. Box: 9000 Wilmington North Carolina 28402-9000 USA
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22
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Zobell JT, Schwab E, Collingridge DS, Ball C, Nohavec R, Asfour F. Impact of pharmacy services on cystic fibrosis medication adherence. Pediatr Pulmonol 2017; 52:1006-1012. [PMID: 28608652 DOI: 10.1002/ppul.23743] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/07/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study is to characterize the impact of pharmacy services on medication adherence and hospitalizations for pediatric cystic fibrosis (CF) patients. METHODS A retrospective health insurance claims analysis and patient medical charts review from January 1, 2014 to December 31, 2016 of patients from the Pediatric Intermountain CF Center was performed. Adherence to dornase alfa and hospital admissions for pulmonary exacerbations pre and post the implementation of an integrated pharmacy team were reviewed. Dornase alfa adherence was measured by the medication possession ratio (MPR) both monthly and yearly. RESULTS Fifty-four patients met inclusion criteria. The mean dornase alfa yearly MPR improved from 0.75 (2014) to 0.92 (2016). Patients were 2.8 times more likely to be adherent to dornase alfa when followed by integrated pharmacy team model (P < 0.001), and 2.4 times more likely to be adherent when followed by a dedicated CF clinic pharmacist only (P = 0.001). CONCLUSION The study demonstrated that pharmacy services improved adherence to dornase alfa.
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Affiliation(s)
- Jeffery T Zobell
- Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah.,Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah
| | | | | | | | | | - Fadi Asfour
- Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah.,Pediatric Pulmonology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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23
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Barati O, Dorosti H, Talebzadeh A, Bastani P. Accreditation status of hospital pharmacies and their challenges of medication management: A case of south Iranian largest university. J Adv Pharm Technol Res 2016; 7:70-4. [PMID: 27429924 PMCID: PMC4932808 DOI: 10.4103/2231-4040.184590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Considering the importance of accreditation for hospital pharmacies, this study was to determine the challenges of medication management in hospital pharmacies affiliated with Shiraz University of Medical Sciences, Iran. The study was a mix-method research conducted in two qualitative and quantitative phases during the years 2014–2015 in Shiraz, Iran. National Accreditation Standard checklist for hospitals was used for data collection in the first phase, and Delphi method was applied in three rounds to achieve the most challenges of medication management and the related solutions. Results indicated a medium status of accreditation for all three dimensions in the above hospital pharmacies (3.53, 42.15 and 7, respectively). Lack of clinical pharmacists, nonparticipation of the pharmacy director in annual budgeting, lack of access to patient information, discontinuity of pharmaceutical care for patients discharged, defects in pharmacy staff training, lack of legislation in support of pharmacists and lack of adequate access to physicians' prescriptions, shortages in reporting medication errors, and lack of evidence related to microbial contamination are the most challenges extracted from the second phase. It seems that the studied hospital pharmacies encounter numerous problems regarding accreditation, pharmaceutical care as well as appropriate medication management and supply chain. Attempts to solve these problems can play an important role in improving the efficiency and effectiveness of pharmacies in Iran.
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Affiliation(s)
- Omid Barati
- Health Human Resources Research Center, Department of Health Service Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hesam Dorosti
- Department of Food and Drug Deputy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Talebzadeh
- Health Human Resources Research Center, Department of Health Service Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Health Human Resources Research Center, Department of Health Service Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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24
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Kheir N, Awaisu A, Gad H, Elazzazy S, Jibril F, Gajam M. Clinical pharmacokinetics: perceptions of hospital pharmacists in Qatar about how it was taught and how it is applied. Int J Clin Pharm 2015; 37:1180-7. [PMID: 26337835 DOI: 10.1007/s11096-015-0183-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The application of clinical pharmacokinetics (PK) is essential when providing pharmaceutical care. Appropriate application of PK monitoring results in improved patient outcomes including decreased mortality, length of treatment, length of hospital stay, and adverse effects of drug therapy. Despite the well-documented evidence of benefits of clinical PK services, many pharmacists find it challenging to apply PK in clinical practice. OBJECTIVE To evaluate pharmacists' training backgrounds, attitude, practices, and perceived barriers pertaining to the application of PK in clinical practice in Qatar. SETTING All hospitals under Hamad Medical Corporation, the main healthcare provider in Qatar. METHODOLOGY This was a cross-sectional, descriptive study that was conducted between October 2012 and January 2013, using a self-administered web-based survey. Pharmacists were eligible to participate if they: (1) were working as full-time hospital pharmacists and; (2) have been in practice for at least 1 year. MAIN OUTCOME MEASURES PK contents learned in undergraduate curriculum; perception towards the PK contents and instructions received in the undergraduate curriculum and; application of PK in current clinical practice. RESULTS A total of 112 pharmacists responded to the questionnaire. The majority of the respondents (n = 91; 81.3 %) reported that they had received PK course(s) in their undergraduate curriculum. Similarly, the majority (70-80 %) of them agreed that the undergraduate PK courses or contents they received were important and relevant to their current practice. The pharmacists identified spending more time on dispensing and inventory issues rather than clinical practice, scarce resources, and manual rather than computerized PK calculations as some of the barriers they encountered in learning about PK and its application. The characteristics of the surveyed pharmacists such as gender, age, highest academic degree, and country of graduation did not influence the pharmacists' perception and attitudes towards PK teaching and application (p > 0.05). CONCLUSION PK course contents were perceived to lack depth and relevance to practice, and pharmacist had no experiential training that included aspects of PK. These, and other issues, result in poor application of PK in practice.
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Affiliation(s)
- Nadir Kheir
- College of Pharmacy, Qatar University, Doha, Qatar.
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Hoda Gad
- Weill Cornell Medical College-Qatar, Qatar Foundation, Doha, Qatar
| | - Shereen Elazzazy
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Farah Jibril
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Mawadda Gajam
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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25
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Covvey JR, Grant J, Mullen AB. Development of an obstetrics triage tool for clinical pharmacists. J Clin Pharm Ther 2015; 40:539-544. [PMID: 26111223 DOI: 10.1111/jcpt.12301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/18/2015] [Indexed: 12/31/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Obstetrics services are a high-throughput and high-risk environment poised for pharmacist involvement, but determining how to ideally allocate services is difficult. There is recent interest in the development of tools for service prioritization, but none are specifically targeted to obstetrics. Therefore, the aim of this study was (i) to conduct a practice audit surveying the demographics of patients attending obstetrics wards at a high-capacity maternity hospital; and (ii) to evaluate a triage tool developed to prioritize pharmacy services. METHODS A retrospective case review of women discharged after birth admissions was undertaken at a hospital in National Health Service (NHS) Scotland during June 2014. Demographic and admission data were collected, as well as pharmacist interventions and missed opportunities in patient care on post-natal wards. A pharmacy triage tool was developed and retrospectively applied to each case to ascertain a risk category that would trigger and target pharmacist review. Interventions/opportunities were classified as either clinical (medication related) or administrative (potential for error development). RESULTS AND DISCUSSION One hundred and seventy-five cases were reviewed with a median age of 29 years old. Eighty-six patients (49·1%) were retrospectively classified with elevated risk using the triage tool. A total of 117 charts (66·9%) were identified with missed opportunities for pharmacist intervention, which was significantly greater among patients classified as higher risk (75·6 vs. 58·4%, P = 0·017). Compared to low-risk patients, patients with a higher-risk classification had lower rates of administrative missed opportunities (55·4 vs. 80·8%, P = 0·015), but numerically higher rates of clinical (26·2 vs. 9·6%, p=NS) and mixed clinical/administrative (18·5 vs. 9·6%, p=NS) missed opportunities, although this failed to reach statistical significance. WHAT IS NEW AND CONCLUSION Evaluation of a triage tool for obstetric services demonstrated potential for prioritizing higher-risk patients for pharmacist review and addressing opportunities for clinical improvements.
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Affiliation(s)
- J R Covvey
- Division of Clinical, Social and Administrative Sciences, Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA
| | - J Grant
- Obstetrics and Gynaecology, Women and Children's Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A B Mullen
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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