Point-of-care testing in pharmacies-An evaluation of the service from the lens of resource-based theory of competitive advantage

Implementation science and entrepreneurship: Two complementary frameworks for advancing pharmacy practice

BACKGROUND

Academic leaders and clinicians have promoted implementation science (IS) and entrepreneurship (EN) as frameworks for transforming pharmacy education and practice. Although distinct, IS and EN share many of the same processes and goals in promoting solutions to problems in healthcare.

OBJECTIVES

To distinguish the similarities and differences between IS and EN. Major components of each method will be evaluated for relative strengths and limitations in advancing pharmacy practice interventions.

METHODS

Basic components of IS and EN were compared. The Consolidated Framework for Implementation Research Intervention (CFIR) was used to represent the elements of IS and the resource-based theory of competitive advantage was used to operationalize key constructs in entrepreneurship. The five CFIR domains matched well with the five constructs of the resource-based theory of competitive advantage, allowing five common components for comparisons: (1) intervention, (2) cost benefit, (3) market viability, (4) organizational setting, and (5) characteristics of the individuals and inputs.

RESULTS

IS and EN are two scholarly approaches that differ primarily in how they frame research questions. IS frameworks prioritize the study of the implementation of evidence-based interventions and their theoretical contributions. They focus predominantly on quantifying the impact of the intervention and less so on the needs of community partners, market viability of intervention, and return on investment. EN is more open to interventions that lack strong objective evidence for effectiveness, relying more on what makes an intervention financially sustainable and profitable in markets.

CONCLUSION

IS and EN both examine the role of the intervention, organization, market viability, inputs, and financial return on the successful adoption and sustainability of interventions. Either framework can be used to advance the adoption and dissemination of pharmacy practice interventions, as long as researchers understand the limitations of each framework.

Evaluation of a pharmacist-led drive-up anticoagulation clinic during the coronavirus 2019 pandemic

Background

The University of Kentucky HealthCare Anticoagulation Clinic at the Gill Heart and Vascular Institute in Lexington, Kentucky, designed and implemented a drive-up clinic for warfarin management with the goal to minimize person-to-person exposure during the coronavirus disease 2019 (COVID-19) pandemic.

Objective

The purpose of this study was to evaluate the effect on warfarin management in a pharmacist-led anticoagulation service when transitioned from an in-person clinic to a drive-up clinic during the COVID-19 pandemic.

Methods

This is a retrospective observational cohort study of 68 patients seen in the University of Kentucky HealthCare Anticoagulation Clinic on warfarin therapy for any indication. Patients were included if they had scheduled visits at least 3 times in the period 6 months before, during, and after the initiation of the drive-up clinic. The primary outcome is the difference in time in therapeutic range (TTR) before and during the drive-up clinic.

Results

The difference between the mean TTR in period 1 (69.1% ± 23.2%) and period 2 (69.6% ± 19.2%) was not statistically significant (P = 0.882). The mean TTR in period 3 (70.5% ± 20.8%) did not differ in statistical significance from either period 1 (P = 0.688) or period 2 (P = 0.746). Safety outcomes including reported bleeding events and emergency department visits or hospital admissions for bleeding or thrombotic events were consistently low across each period.

Conclusion

The results of this study illustrate that a drive-up clinic for warfarin management may be a reasonable alternative approach to providing care for outpatient anticoagulant management and may support nontraditional clinic models for long-term management of anticoagulation and other chronic disease states.

Using the Business Model Canvas to Guide Doctor of Pharmacy Students in Building Business Plans

Objective. To review the use of the business model canvas, a one-page visual description of a business initiative, as a tool for teaching pharmacy students about entrepreneurship and business planning in pharmacy practice settings.Findings. Students often struggle to develop the mindset, skillset, and toolset to effectively apply business modeling and planning processes to pharmacy practice settings. Over years of experimentation and various iterations in a pharmacy practice management class, a new business model canvas was developed and refined. The canvas contains 13 sections which emphasize key terms, concepts, and ideas crucial for achieving entrepreneurial competencies. Using the zone of proximal development as a framework, the course structure offered a range of supportive activities that guided students to independent competence. The business model canvas formed a framework around which assigned course readings, exercises, and group assignments helped pharmacy students build confidence and competence in completing a capstone business plan assignment.Summary. This paper provides recommendations and examples of how to structure a course in the Doctor of Pharmacy curricula using an entrepreneurial tool, the business model canvas, to help students master business competencies. Recommendations and lessons-learned are provided.

Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions

In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists' roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies - including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models' perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks.