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Khalil K, Lyons J, Teuteberg JJ, Henricksen EJ. The Impact of the COVID-19 Pandemic on the Transplant Pharmacist Workforce. J Pharm Pract 2024; 37:296-300. [PMID: 36206374 PMCID: PMC9548482 DOI: 10.1177/08971900221131906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: The COVID-19 pandemic has placed an unprecedented strain on the US healthcare system, greatly impacting transplant centers. Objective: The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Methods: A survey was disseminated electronically to assess the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Respondents were asked to give background regarding transplant center, patient, population, and departmental staffing. Results: There were 67 total respondents from 56 transplant centers. In response to the COVID-19 pandemic, 55% of centers reported stopping non-life saving transplants, and a majority (89%) stopped living donor transplants altogether. The banning of caregivers on-site during education, reduction of bedside education teaching, and cancelling of group teaching classes occurred at 46%, 40%, and 22% of centers, respectively. Consequently, 42% of pharmacists surveyed felt that their confidence in patient and caregiver's understanding of medications had decreased since these changes have been implemented. Conclusions: Pharmacist perception of patient and caregiver understanding of transplant medications has decreased since before the COVID-19 pandemic. As health systems strategize resource allocation throughout the pandemic, the importance of patient education must be prioritized to sustain and improve transplant outcomes.
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Affiliation(s)
- Karen Khalil
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - John Lyons
- Department of Pharmacy, Loyola University Medical
Center, Maywood, IL, USA
| | - Jeffrey J. Teuteberg
- Department of Medicine and Section
of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Stanford University, CA, USA
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2
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Promraj R, Susomboon T, Tovikkai C, Kositamongkol P. Improving Patient Safety in Medication Management by Medication Reconciliation and Pharmaceutical Care Process in Post-Liver Transplant Clinic. Transplant Proc 2024; 56:620-624. [PMID: 38350823 DOI: 10.1016/j.transproceed.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Liver transplant recipients receive many medications for anti-rejection, infection prophylaxis, and treatment of comorbidities. Most of them also receive medications from multiple sources. Therefore, these patients are prone to drug-related problems (DRPs) and medication errors. This study aimed to study the effect of medication reconciliation (MR) and pharmaceutical care processes by transplant pharmacists in the post-liver transplant clinic. METHODS This study was a retrospective study in Siriraj Liver Transplant Center, Mahidol University, Thailand. Patients who received pharmaceutical care from transplant pharmacists were compared before and after the implementation of MR (October 2020-September 2021 vs October 2021-September 2022) to assess the prevalence of medication errors and identify DRPs between the 2 groups. RESULTS Before implementation of MR, in a total of 797 visits, 69 medication errors (8.7%) were found. The most errors were medication omissions (44.9%, n = 31). After the implementation of MR, in a total of 879 visits, 44 medication errors (5.0%) were found. Most were medication omission and incorrect strength (31.8%, n = 14). Medication errors significantly decreased by 36.2% (P < .001) after the implementation of MR. Regarding DRPs, transplant pharmacists could significantly detect more DRPs after implementation of MR, 66 DRPs before implementation of MR vs 111 DRPs after implementation of MR (P < .001). The most DRPs were non-adherence (34 vs 41). CONCLUSIONS MR can reduce medication errors and assist transplant pharmacists in identifying DRPs that will lead to active intervention by attending physicians and/or patients to improve medication management and patient safety in post-liver transplant care.
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Affiliation(s)
- Ratchawat Promraj
- Outpatient Pharmaceutical Care Unit, Pharmacy Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teerada Susomboon
- Outpatient Pharmaceutical Care Unit, Pharmacy Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chutwichai Tovikkai
- Hepato-Pancreato-Biliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prawat Kositamongkol
- Hepato-Pancreato-Biliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Chandran MM, Cohen E, Doligalski CT, Bowman LJ, Kaiser TE, Taber DJ. The measure of impact: Proposal of quality metrics for solid organ transplant pharmacy practice. Am J Transplant 2024; 24:164-176. [PMID: 37923084 DOI: 10.1016/j.ajt.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
As healthcare continues its transition toward value-based care, it is increasingly important for transplant pharmacists to demonstrate their impact on patient care, health-related outcomes, and healthcare costs. Evidence-based quality and performance metrics are recognized as crucial tools for measuring the value of service. Yet, there is a lack of well-developed and agreed-upon specific metrics for many clinical pharmacy specialties, including solid organ transplantation. To address this need, a panel of transplant pharmacy specialists conducted a detailed literature review and engaged in several panel discussions to identify quality metrics to be considered for assessing the value of clinical pharmacy services provided to solid organ transplant recipients and living donors. The proposed metrics are based on the Donabedian model and are categorized to coincide with the typical phases of transplant care. The measures focus on key issues that arise in transplant recipients related to medication therapy, including adverse drug events, nonadherence, and clinical outcomes attributable to medication therapy management. This article proposes a comprehensive set of measures, any number of which transplant pharmacists can adopt and measure over time to objectively gauge the value of services they are providing to transplant recipients, the transplant center, and the overall healthcare system.
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Affiliation(s)
- Mary Moss Chandran
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
| | - Elizabeth Cohen
- Department of Transplant, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Lyndsey J Bowman
- Department of Pharmacy, Tampa General Hospital, Tampa, Florida, USA
| | - Tiffany E Kaiser
- Division of Digestive Diseases, Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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4
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Gold A, Wray J, Kosmach-Park B, Bannister L, Wichart J, Graham A, Piotrowski C, Mayersohn G, Shellmer DA, Patterson C. Allied health and nursing practices in pediatric solid organ transplantation: An international survey. Pediatr Transplant 2024; 28:e14541. [PMID: 37550265 DOI: 10.1111/petr.14541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION With improved survival in pediatric solid organ transplantation (SOT) care has focused on optimizing functional, developmental, and psychosocial outcomes, roles often supported by Allied Health and Nursing professionals (AHNP). However, there is a scarcity of research examining frameworks of clinical practice. METHODS The International Pediatric Transplant Association AHNP Committee developed and disseminated an online survey to transplant centers as a quality improvement project to explore AHNP practice issues. Participant responses were characterized using descriptive statistics, and free-text comments were thematically analyzed. Responses were compared across professional groups; Group 1: Advanced Practice Providers, Group 2: Nursing, Group 3: Allied Health. RESULTS The survey was completed by 119 AHNP from across the globe, with responses predominantly (78%) from North America. Half of respondents had been working in pediatric transplant for 11+ years. Two-thirds of respondents were formally funded to provide transplant care; however, of these not funded, over half (57%) were allied health, compared to just 6% of advance practice providers. Advanced practice/nursing groups typically provided care to one organ program, with allied health providing care for multiple organ programs. Resource constraints were barriers to practice across all groups and countries. CONCLUSION In this preliminary survey exploring AHNP roles, professionals provided a range of specialized clinical care. Challenges to practice were funding and breadth of care, highlighting the need for additional resources, alongside the development of clinical practice guidelines for defining, and supporting the role of AHNP within pediatric SOT. Professional organizations, such as IPTA, can offer professional advocacy.
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Affiliation(s)
- Anna Gold
- The Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Beverly Kosmach-Park
- Department of Transplant Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - Louise Bannister
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jenny Wichart
- Department of Pharmacy, Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Ashley Graham
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, The University of Toronto, Toronto, Ontario, Canada
| | - Caroline Piotrowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gillian Mayersohn
- St. Louis Children's Hospital, St. Louis, Missouri, USA
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Diana A Shellmer
- Department of Surgery, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine Patterson
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Department of Rehabilitation Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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Korzec J, Strausbaugh R, Mikolay JJ, Churchwell MD. Rhabdomyolysis and acute kidney injury potentiated by a drug-drug interaction between cyclosporine, leflunomide, and rosuvastatin in a kidney transplant recipient: A missed opportunity for pharmacist involvement. J Am Pharm Assoc (2003) 2024:S1544-3191(24)00019-0. [PMID: 38272309 DOI: 10.1016/j.japh.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND This study aimed to describe a case of rhabdomyolysis and acute kidney injury potentiated by a drug-drug interaction (DDI) between cyclosporine, leflunomide, and rosuvastatin in a kidney transplant recipient. CASE SUMMARY A 74-year-old male with end-stage kidney disease secondary to type 2 diabetes mellitus and hypertension received a deceased by cardiac death kidney transplant. The patient's medical history included coronary artery disease and hyperlipidemia for which he was receiving rosuvastatin 40 mg daily. Five months after transplant, the patient developed BK viremia, which required multiple changes in immunosuppression and resulted in the initiation of leflunomide and cyclosporine modified. The patient used multiple pharmacies and coupon cards that delayed the identification of the DDIs between leflunomide, cyclosporine, and rosuvastatin. Approximately, 13 months after transplant, the biopsy report of the patient's allograft kidney showed acute cellular rejection Banff IB, hypertensive changes, and transplant glomerulopathy. This prompted the patient to receive a 3-day course of methylprednisolone 250 mg intravenous at the outpatient infusion center. Two weeks later, the patient presented to the transplant clinic with lightheadedness, dizziness, weakness, fatigue, bilateral eye drainage, and a decrease in appetite and was admitted to the hospital for further workup. On admission, creatine kinase was 2080 IU/L with myoglobin of 7601 ng/mL. The patient's diagnosis was statin myopathy with possible rhabdomyolysis acute kidney injury. Likely contributing factors included cyclosporine, leflunomide, and rosuvastatin DDI and administration of high-dose methylprednisolone. PRACTICE IMPLICATIONS This case demonstrates the importance of pharmacist involvement throughout all phases of care in a kidney transplant recipient.
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Taber DJ, Ward RC, Buchanan CH, Axon RN, Milfred-LaForest S, Rife K, Felkner R, Cooney D, Super N, McClelland S, McKenna D, Santa E, Gebregziabher M. Results of a multicenter cluster-randomized controlled clinical trial testing the effectiveness of a bioinformatics-enabled pharmacist intervention in transplant recipients. Am J Transplant 2023; 23:1939-1948. [PMID: 37562577 DOI: 10.1016/j.ajt.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
An ambulatory medication safety dashboard was developed to identify missing labs, concerning labs, drug interactions, nonadherence, and transitions in care. This system was tested in a 2-year, prospective, cluster-randomized, controlled multicenter study. Pharmacists at 5 intervention sites used the dashboard to address medication safety issues, compared with usual care provided at 5 control sites. A total of 2196 transplant events were included (1300 intervention vs 896 control). During the 2-year study, the intervention arm had a 11.3% (95% confidence interval, 7.1%-15.5%) absolute risk reduction of having ≥1 emergency department (ED) visit (44.2% vs 55.5%, respectively; P < .001, respectively) and a 12.3% (95% confidence interval, 8.2%-16.4%) absolute risk reduction of having ≥1 hospitalization (30.1% vs 42.4%, respectively; P < .001). In those with ≥1 event, the median ED visit rate (2 [interquartile range (IQR) 1, 5] vs 2 [IQR 1, 4]; P = .510) and hospitalization rate (2 [IQR 1, 3] vs 2 [IQR 1, 3]; P = .380) were similar. Treatment effect varied by comorbidity burden, previous ED visits or hospitalizations, and heart or lung recipients. A bioinformatics dashboard-enabled, pharmacist-led intervention reduced the risk of having at least one ED visit or hospitalization, predominantly demonstrated in lower risk patients.
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Affiliation(s)
- David J Taber
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Ralph C Ward
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Casey H Buchanan
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA
| | - Robert Neal Axon
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA
| | - Sherry Milfred-LaForest
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Kelsey Rife
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Rebecca Felkner
- Department of Pharmacy Services, William S. Middleton Veterans Affairs Medical Center, Madison, Wisconsin, USA
| | - Danielle Cooney
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Nicholas Super
- Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Samantha McClelland
- Department of Pharmacy Services, Veterans Affairs Great Lakes Health Care System (VISN 12), Westchester, Illinois, USA
| | - Domenica McKenna
- Department of Pharmacy Services, Portland Veterans Affairs Health Care System, Portland, Oregon, USA
| | - Elizabeth Santa
- Department of Pharmacy Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
| | - Mulugeta Gebregziabher
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Jibai N, Koch A, Ulmer TF, Erdmann P, Koeck JA, Eisert A. Pharmaceutical Interventions for Inpatients with Liver Cirrhosis and Liver Transplantation: A Systematic Review of Experimental Studies. J Clin Med 2023; 12:7030. [PMID: 38002644 PMCID: PMC10671912 DOI: 10.3390/jcm12227030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Liver cirrhosis, which is considered one of the leading causes of death in the world, can lead to severe complications, and is often followed by a liver transplantation. These patients take an average of nine medications daily. If not managed adequately, it can be accompanied by serious drug-related problems. To reduce this risk, a clinical pharmacist may be included as part of the healthcare team to optimize medication therapy in this population. This study aimed to systematically identify the pharmaceutical interventions which reduced drug-related problems and improved medication therapy for adult hospitalized liver cirrhotic and liver transplant patients when compared to standard care. Three databases (PubMed, Embase, and CENTRAL) were systematically searched from the inception of each database to 25 October 2023, and interventional studies in the English language were included. The risk of bias was assessed according to RoB-I for the UBA study and RoB2 for the identified RCT. The detected interventions to reduce drug-related problems in liver cirrhotic and liver transplant patients were extracted and classified according to a "Hierarchy of Controls" model. Two studies from Germany and the USA met our inclusion criteria, respectively. In these studies, we identified two interventions that included education, expert consultation, and the monitoring of the immunosuppressive medications serum level. The main objective of the two included studies was improving patients' compliance through adherence. These pharmaceutical interventions identified were classified as administrative controls, which is one of the lowest levels in the "Hierarchy of Controls" with which to address a potential risk. Pharmaceutical interventions to optimize medication therapy were found to be rare in the examined population, and were limited to "administrative controls". These interventions were limited to transplant patients' education and the monitoring of the immunosuppressive medication serum levels. No interventional studies were found to have investigated pharmaceutical interventions in patients with liver cirrhosis. Especially regarding this patient group, future studies to reduce DRPs using pharmaceutical interventions are needed. This study received no external funding and its PROSPERO registration number is CRD42022309122.
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Affiliation(s)
- Nagham Jibai
- Hospital Pharmacy, RWTH Aachen University Hospital, 52074 Aachen, Germany; (N.J.); (P.E.)
| | - Alexander Koch
- Department of Internal Medicine III, RWTH Aachen University Hospital, 52074 Aachen, Germany;
| | - Tom Florian Ulmer
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany;
| | - Pia Erdmann
- Hospital Pharmacy, RWTH Aachen University Hospital, 52074 Aachen, Germany; (N.J.); (P.E.)
| | | | - Albrecht Eisert
- Hospital Pharmacy, RWTH Aachen University Hospital, 52074 Aachen, Germany; (N.J.); (P.E.)
- Institute of Clinical Pharmacology, RWTH Aachen University Hospital, 52074 Aachen, Germany
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8
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Jang HY, Kim YS, Oh JM. Clinical Effectiveness of Renal Transplant Outpatient Pharmaceutical Care Services in Korea. Healthcare (Basel) 2023; 11:2597. [PMID: 37761794 PMCID: PMC10531252 DOI: 10.3390/healthcare11182597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The necessity and importance of pharmaceutical care services (PCS) are well recognized, yet the concept and scope of PCS have not yet been clearly defined in Korea, particularly in kidney transplantation outpatient clinics. AIM The main purpose of this study is to evaluate whether PCS is effective in the outpatient setting for kidney transplant patients. METHODS For three years, a clinical pharmacist provided PCS to kidney transplant patients in an outpatient setting to evaluate the clinical effectiveness of PCS. RESULTS A total of 302 patients were matched in a 1:1 ratio, with 151 in the PCS group and 151 in the control group. These patients were followed, and a total of 476 interventions were provided to them, including medication reconciliation (n = 113, 23.7%), medication evaluation and management (n = 186, 39.1%), and pharmaceutical care transition (n = 177, 37.2%) services. The estimated glomerular filtration rate (eGFR) exhibited a notable difference between the control and PCS groups when comparing the pre- and post-study periods measurements. In the control group, there was a decline of 7.0 mL/min/1.73 m2 in eGFR. In contrast, the PCS group showed a smaller decline of 2.5 mL/min/1.73 m2 (p = 0.03). The adjusted odds ratio for end stage renal disease development in the PCS group was 0.51 (95% confidence interval: 0.26-0.96), indicating a significantly lower risk compared to the control group. CONCLUSION Our study highlights the promising potential of PCS implementation in kidney transplantation outpatient clinics. Further research is needed to validate and expand upon these findings, especially in diverse clinical settings.
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Affiliation(s)
- Ha Young Jang
- College of Pharmacy, Gachon University, Incheon 21936, Republic of Korea;
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea;
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
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Lichvar AB, Chandran MM, Cohen EA, Crowther BR, Doligalski CT, Condon Martinez AJ, Potter LMM, Taber DJ, Alloway RR. The expanded role of the transplant pharmacist: A 10-year follow-up. Am J Transplant 2023; 23:1375-1387. [PMID: 37146942 DOI: 10.1016/j.ajt.2023.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/02/2023] [Accepted: 04/30/2023] [Indexed: 05/07/2023]
Abstract
The role of the transplant pharmacist is recognized by transplant programs, governmental groups, and professional organizations as an essential part of the transplant multidisciplinary team. This role has evolved drastically over the last decade with the advent of major advances in the science of transplantation and the growth of the field, which necessitate expanded pharmacy services to meet the needs of patients. Data now exist within all realms of the phases of care for a transplant recipient regarding the utility and benefit of a solid organ transplant (SOT) pharmacist. Furthermore, governing bodies now have the opportunity to use Board Certification in Solid Organ Transplant Pharmacotherapy as a mechanism to identify and recognize specialty knowledge and expertise within the field of SOT pharmacotherapy. The purpose of this paper is to provide an overarching review of the current and future state of SOT pharmacy while also identifying major changes to the profession, forthcoming challenges, and expected areas of growth.
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Affiliation(s)
- Alicia Beth Lichvar
- Center for Transplantation, University of California San Diego Health, La Jolla, California, USA.
| | | | - Elizabeth A Cohen
- Department of Transplantation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Barrett R Crowther
- Department of Pharmacy, University of Colorado Health, Aurora, Colorado, USA
| | | | | | - Lisa M M Potter
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
| | - David J Taber
- Division of Transplantation, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rita R Alloway
- Division of Nephrology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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10
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Pharmacotherapeutic Interventions in People Living With HIV Undergoing Solid Organ Transplantation: A Scoping Review. Transplant Direct 2023; 9:e1441. [PMID: 36733439 PMCID: PMC9886517 DOI: 10.1097/txd.0000000000001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 01/28/2023] Open
Abstract
The pharmacotherapeutic management of people living with HIV (PLWHIV) undergoing solid organ transplantation (SOT) is clinically challenging, mainly due to the frequent occurrence of complex drug-drug interactions. Although various strategies have been proposed to improve treatment outcomes in these patients, several uncertainties remain, and consensus practice guidelines are just beginning to emerge. The main objective of this scoping review was to map the extent of the literature on the pharmacotherapeutic interventions performed by healthcare professionals for PLWHIV undergoing SOT. Methods We searched Medline, Embase, and the Cochrane databases as well as gray literature for articles published between January 2010 and February 2020. Study selection was performed by at least 2 independent reviewers. Articles describing pharmacotherapeutic interventions in PLWHIV considered for or undergoing SOT were included in the study. Results Of the 12 599 references identified through our search strategy, 209 articles met the inclusion criteria. Results showed that the vast majority of reported pharmacotherapeutic interventions concerned the management of immunosuppressive and antimicrobial therapy, including antiretrovirals. Analysis of the data demonstrated that for several aspects of the pharmacotherapeutic management of PLWHIV undergoing SOT, there were differing practices, such as the choice of immunosuppressive induction and maintenance therapy. Other important aspects of patient management, such as patient counseling, were rarely reported. Conclusions Our results constitute an extensive overview of current practices in the pharmacotherapeutic management of SOT in PLWHIV and identify knowledge gaps that should be addressed to help improve patient care in this specific population.
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11
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A Multicenter Survey Study of Lung Transplant Program Staffing. Transplantation 2022; 107:1013-1016. [PMID: 36584370 PMCID: PMC10125118 DOI: 10.1097/tp.0000000000004478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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12
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Felkner R, Barnett SG, Misch EA, Safdar N, Balasubramanian P. Antimicrobial stewardship in solid organ transplantation: Perspective from a Veterans Affairs Medical Center. Transpl Infect Dis 2022; 24:e13948. [DOI: 10.1111/tid.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Rebecca Felkner
- The William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
| | - Susanne G. Barnett
- The William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- University of Wisconsin School of Pharmacy Madison Wisconsin USA
| | - Elizabeth A. Misch
- Division of Infectious Disease, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Nasia Safdar
- The William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Division of Infectious Disease, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
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Rech MA, Gomez TA. What generates critical care pharmacist positions in the "real world"? Am J Health Syst Pharm 2022; 79:1513-1514. [PMID: 35704704 DOI: 10.1093/ajhp/zxac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Megan A Rech
- Department of Pharmacy, Loyola University Medical Center, Chicago, IL.,Department of Emergency Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Tad A Gomez
- Loyola University Medical Center, Chicago, IL, USA
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Einsfeld L, Hastenteufel LCT, Taber D, Clausell N, Goldraich LA. Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action. J Clin Pharm Ther 2021; 47:588-591. [PMID: 34841539 DOI: 10.1111/jcpt.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Clinical pharmacists' involvement in the care of solid organ transplant recipients has been discussed worldwide given its potential to improve clinical outcomes. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programmes nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centres in Brazil and compared them with accredited programmes in the United States. METHODS An electronic questionnaire was distributed to all 40 heart and lung transplant centres registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. Survey findings were compared to previously published data from accredited U.S. centres. RESULTS AND DISCUSSION From 22 centre respondents, ten (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translated into 158 (37.6%) transplant recipients without any direct pharmaceutical care. In centres with pharmacists (n = 12), none had a full-time professional dedicated to their heart and/or lung programmes. When compared to U.S. centres, there was a significantly lower insertion of clinical pharmacist activities among Brazilian centres. WHAT IS NEW AND CONCLUSION Our findings point to an unmet need related to clinical pharmacy activity within thoracic transplant programmes, especially in a developing country, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.
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Affiliation(s)
- Lídia Einsfeld
- Division of Clinical Pharmacy, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - David Taber
- Division of Transplant Surgery, Ralph H Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Nadine Clausell
- Division of Cardiology, Graduate Studies in Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Livia Adams Goldraich
- Division of Cardiology, Graduate Studies in Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Acquisto NM, Beavers CJ, Bolesta S, Buckley MS, Dobbins KF, Finch CK, Hayes SM, Holdren DB, Johnson ST, Kane‐Gill SL, Lat I. Development and application of quality measures of clinical pharmacist services provided in inpatient/acute care settings. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Scott Bolesta
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | | | | | - Ishaq Lat
- American College of Clinical Pharmacy Lenexa Kansas USA
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16
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Doligalski CT, Anger LB, Dick T, Feist A, Harris M, Masters B, Pilch N, Quan D, Sparkes T, Suarez T, Yakubu I. Considerations and approaches to expansion of solid organ transplant pharmacist services. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Travis Dick
- Department of Pharmacy University of Rochester Medical Center Rochester New York USA
| | - Ashley Feist
- Department of Pharmacy UC San Diego San Diego California USA
| | - Matt Harris
- Department of Pharmacy Duke University Hospitals Durham North Carolina USA
| | - Brian Masters
- Department of Pharmacy University of Maryland Medical Center Baltimore Maryland USA
| | - Nicole Pilch
- Department of Transplant Medical University of South Carolina Charleston South Carolina USA
| | - David Quan
- Department of Clinical Pharmacy UCSF Health San Francisco California USA
| | - Tracy Sparkes
- Department of Pharmacy University of Maryland Medical Center Baltimore Maryland USA
| | - Tricia Suarez
- Department of Pharmacy University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Idris Yakubu
- Department of Pharmacy Virginia Commonwealth University Health System Richmond Virginia USA
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17
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Horwedel TA, Crowther BR, Lourenco Jenkins LM, Doligalski CT, Geyston J, Suarez T, Fleming JN. Survey‐based
assessment of shifting trends in first solid organ transplant pharmacist jobs. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Jennifer Geyston
- University of Virginia Health System Charlottesville Virginia USA
| | | | - James N. Fleming
- Medical University of South Carolina Charleston South Carolina USA
- Transplant Genomics, Inc Mansfield Massachusetts USA
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18
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Lichvar A, Chandran MM, Do V, Rendulic T, Szczepanik A, Pierce D, Park JM. Entrustable professional activities for pharmacy students: A primer for solid organ transplant preceptors. Am J Health Syst Pharm 2021; 78:zxab320. [PMID: 34350946 DOI: 10.1093/ajhp/zxab320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The role of a solid organ transplant pharmacist is multifaceted and translates to diverse experiential and elective learning experiences that can be provided to pharmacy learners. Here we provide a guide to integrating pharmacy students into patient care and other pharmacist activities in solid organ transplantation. SUMMARY Thoughtful incorporation of learners into clinical practice and clinical research creates a positive learning environment for pharmacy students that can foster the development of core skills necessary for students to become "practice-ready" and "team-ready" pharmacy graduates and can equip them with valuable skills to incorporate into the specialty practice areas and careers they pursue. To help develop these educational experiences, attention to the list of core entrustable professional activities (EPAs) established by the American Association of Colleges of Pharmacy can help create a rich environment of learning with carefully cultivated tasks. Furthermore, learners can serve as transplant pharmacist extenders to assist in overall patient care and multidisciplinary involvement on the transplant team. This article serves as a "how-to" guide for applying the EPA framework to integrating pharmacy students in patient care and other pharmacist activities in solid organ transplantation and other specialty practice areas. CONCLUSION As pharmacy preceptors design and operationalize their teaching to incorporate EPAs, they can benefit from recommendations tailored to specialty practice areas such as solid organ transplantation. Students may start and finish these experiences at different EPA levels, but continuance of training will allow them to achieve the final EPA level across the 6 EPA domains.
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Affiliation(s)
- Alicia Lichvar
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, and Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Vincent Do
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Trisann Rendulic
- Department of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Amanda Szczepanik
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Dana Pierce
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeong M Park
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, and Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
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Meaney CJ, Manley HJ, Pai AB, Battistella M, Hudson JQ, Peter WL. Nephrology practice and research network opinion paper: Pharmacists' perspectives on the Advancing American Kidney Health initiative. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Calvin J. Meaney
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences Buffalo New York USA
| | | | | | - Marisa Battistella
- University of Toronto, Leslie Dan Faculty of Pharmacy, University Health Network‐ Nephrology Toronto Ontario Canada
| | - Joanna Q. Hudson
- The University of Tennessee College of Pharmacy Memphis Tennessee USA
| | - Wendy L. Peter
- University of Minnesota College of Pharmacy Minneapolis Minnesota USA
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