PHARMACISTS | Academic Articles

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Posts Tagged ‘PHARMACISTS’

Implementation of a pharmacy residency in a veterans affairs community-based outpatient clinic

Purpose. The implementation of an innovative ambulatory care pharmacy residency program at a Veterans Affairs (VA) outpatient clinic is described. Summary. Community-based outpatient clinics (CBOCs) are a largely underutilized resource for pharmacy residency training. Through a collaboration of the University of Georgia College of Pharmacy in Athens and Charlie Norwood VA Medical Center in Augusta, a postgraduate year 2 (PGY2) pharmacy residency program was established at the CBOC in Athens. The program graduated its first resident in 2009; components of training included (1) disease state management at an anticoagulation clinic and a newly created disease state-focused pharmacotherapy clinic, (2) participation in the planning and implementation of a new lipid management service, (3) a variety of didactic, laboratory, and experiential teaching activities at the college of pharmacy, and (4) management experiences such as completing requests for nonformulary medications, management of drug shortages, adverse drug reaction reporting, and participation in meetings of local and regional VA pharmacy and therapeutics committees. The demonstrated value of the ongoing program led to position upgrades for two CBOC clinical pharmacists and the addition of a clinical faculty member, enabling the program to offer additional learning experiences and preceptorship opportunities. Conclusion. A PGY2 ambulatory care residency program established in a CBOC provided a novel practice setting for the resident, helped improve patient care and pharmacy student education, and assisted in the professional development of preceptors and providers at the training site. [ABSTRACT FROM AUTHOR]

May 15, 2012 Tags: AMBULATORY medical care, ANTILIPEMIC agents, CLINICAL medicine, DRUG monitoring, EDUCATIONAL outcomesTHERAPEUTIC use, HOSPITALS -- Outpatient services, HUMAN services programs, INTERNSHIP programs, PHARMACISTS, PHARMACY -- Study & teaching, SCHOOL environment, VETERANS' hospitals
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Determining the feasibility of objective adherence measurement with blister packaging smart technology

Purpose. The results of a feasibility study of blister-pack smart technology for monitoring medication adherence are reported. Methods. Research in the area of objective therapy compliance measurement has led to the development of microprocessor-driven systems that record the time a unit dose is removed from blister packaging. One device under development is the Smart Blister–a label imprinted with event-detection circuitry that can be affixed to standard commercial blister cards. In the first trial of the device in actual clinical practice, 115 community-dwelling Dutch patients receiving valsartan maintenance therapy (160 mg once daily) were given 14-day blister packages equipped with the Smart Blister. On the return of empty blister cards to the 20 participating community pharmacies, the stored information was scanned and downloaded for data analysis and patient counseling purposes. Results. A total of 245 Smart Blister-equipped packages were used by valsartan recipients during the eight-month study. The device was largely effective in recording patient and blister-card identification data and other desired information. However, in 17% of cases, the Smart Blister system registered multiple tablet-removal events at the same time, presumably indicating unintentional breakage of nearby conductive circuits and the need for design refinements. The Smart Blister-equipped medication cards were generally well received by patients and pharmacies. Conclusion. An evaluation of the functionality and robustness of the Smart Blister in a real-world clinical practice situation yielded some promising results, but the findings also indicated a need for design refinements and additional performance testing of the device. [ABSTRACT FROM AUTHOR]

May 15, 2012 Tags: CARDIOVASCULAR system -- Diseases, DATA analysis -- Software, DESCRIPTIVE statistics, DRUGS -- Labeling, DRUGS -- Packaging, DRUGS -- Testing, DRUGSTORES, LONGITUDINAL method, METHODOLOGY, PATIENT compliance, PHARMACISTS, PILOT projects, QUESTIONNAIRES, RADIO frequency identification systems, SMART cards, VALSARTAN (Drug), WIRELESS communication systems
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A pharmacoeconomic modeling approach to estimate a value-based price for new oncology drugs in europe

Background. Several European governments have recently mandated price cuts in drugs to reduce health care spending. However, such measures without supportive evidence may compromise patient care because manufacturers may withdraw current products or not launch new agents. A value-based pricing scheme may be a better approach for determining a fair drug price and may be a medium for negotiations between the key stakeholders. To demonstrate this approach, pharmacoeconomic (PE) modeling was used from the Spanish health care system perspective to estimate a value-based price for bevacizumab, a drug that provides a 1.4-month survival benefit to patients with metastatic colorectal cancer (mCRC). The threshold used for economic value was three times the Spanish per capita GDP, as recommended by the World Health Organization (WHO).Methods. A PE model was developed to simulate outcomes in mCRC patients receiving chemotherapy ± bevacizumab. Clinical data were obtained from randomized trials and costs from a Spanish hospital. Utility estimates were determined by interviewing 24 Spanish oncology nurses and pharmacists. A price per dose of bevacizumab was then estimated using a target threshold of €78,300 per quality-adjusted life year gained, which is three times the Spanish per capita GDP.Results. For a 1.4-month survival benefit, a price of €342 per dose would be considered cost effective from the Spanish public health care perspective. The price may be increased to €733 or €843 per dose if the drug were able to improve patient quality of life or enhance survival from 1.4 to 3 months.Conclusions. This study demonstrated that a value-based pricing approach using PE modeling and the WHO criteria for economic value is feasible and perhaps a better alternative to government mandated price cuts. The former approach would be a good starting point for opening dialog between European government payers and the pharmaceutical industry.

March 1, 2012 Tags: ANTINEOPLASTIC agents, CANCER -- Chemotherapy, CANCER -- Nursing, COLON (Anatomy), CONFIDENCE intervals, COST effectiveness, DATA analysis -- Software, DECISION making, DESCRIPTIVE statisticsTHERAPEUTIC useECONOMIC aspects, INTERVIEWING, MONOCLONAL antibodies, OUTCOME assessment (Medical care), PHARMACISTS, PHARMACY, QUESTIONNAIRES, RECTUM, TREATMENT effectiveness, TUMORS
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Development of a residency interviewing preparatory seminar

Purpose. The development of a residency interviewing preparatory seminar (RIPS) is described. Summary. The RIPS elective at Nova Southeastern University College of Pharmacy was designed to assist pharmacy students during their last professional year in preparing for the residency application process. The learning objectives of the course focused on improving students’ interviewing and presentation skills, professionalism, and developing their curriculum vitae (CV) and personal statement. Course and instructor evaluations and demographic data collected via anonymous surveys were used to ascertain students’ perspectives about the course. The class was purposely scheduled to begin in October and end in November, right before the ASHP Midyear Clinical Meeting in early December. Due to limited faculty availability on the scheduled evenings and the desire to provide tailored, in-depth feedback, enrollment was limited. The RIPS was an intensive eight-week elective completed by 10 fourth-year pharmacy students. The course began with an overview of the residency application process, and students submitted their CVs and personal statements to faculty mentors for critique. To simulate residency interview components, students completed several timed activities in class and participated in mock interviews. Students stated that the course improved their application materials, interview skills, and confidence in their ability to obtain a residency. Overall, 78% of RIPS participants matched with a residency program. Conclusion. The RIPS elective was successful in improving residency candidate confidence at the ASHP Midyear Clinical Meeting. Students reported that the course was helpful and improved their confidence and ability to interview. [ABSTRACT FROM AUTHOR]

March 1, 2012 Tags: ABILITY, BEHAVIORAL objectives (Education), CONFIDENCE, COURSE evaluation (Education), CURRICULA (Courses of study), CURRICULUM planning, HEALTH occupations students, HUMAN services programs, INTERNSHIP programs, INTERVIEWING, JOB applications, MENTORING, PHARMACISTS, PHARMACY -- Study & teaching, TRAINING
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Clinical outcomes of a pharmacist-managed anticoagulation service for breast cancer patients

Purpose. Report descriptive outcome measures related to the quality of pharmacist-managed anticoagulation care with warfarin in patients with breast cancer since the formation of the anticoagulation management service (AMS).Methods. Retrospective review of 145 patients with breast cancer (median age 54 years) receiving warfarin therapy for venous thromboembolism (VTE) managed by the pharmacist-run AMS between 1998 and 2005.Results. The median time followed by the AMS was 151 days. Fifty three percent (n = 1651) of total lab draws (n = 3129) were within the target therapeutic INR range 2–3. Recurrent thrombosis occurred in 4.1% of patients. Minor bleeding occurred in 18.6% of patients and major bleeding occurred in three patients (2.1%, gastrointestinal, intra-abdominal, and subdural hematoma).Conclusion. To date, this is the largest known published database of cancer patients receiving anticoagulation in a pharmacist-managed anticoagulation service. Recurrent VTE rates, major and minor bleeding rates, and percentage of time spent within the therapeutic range are slightly different in our patient population compared to an oncology population receiving warfarin and a non-oncology population with warfarin managed by AMS. Oral anticoagulation with warfarin is an effective, albeit complicated, treatment for venous thromboembolism in the oncology population. Although low-molecular weight heparin (LMWH) therapy is now the preferred treatment for thrombosis in malignancy, warfarin is still relevant in patients who are unable to receive treatment with LMWH. This report provides valuable information supporting coordinated anticoagulation therapy with a pharmacist-managed service in a breast cancer-specific population, and contributes to the growing data supporting the challenging nature of maintaining warfarin anticoagulation in patients with cancer.

March 1, 2012 Tags: ACADEMIC medical centers, BLOOD coagulation tests, BREAST, CANCER -- Chemotherapy, DESCRIPTIVE statisticsRISK factorsTHERAPEUTIC use, DISEASES -- Relapse, DRUG monitoring, ESTROGEN -- Antagonists, HEALTH care teams, HEMORRHAGE, HEPARIN, HOSPITAL pharmacies, METHODOLOGY, OUTCOME assessment (Medical care), PHARMACISTS, PHARMACY management, RETROSPECTIVE studies, THROMBOEMBOLISM, TREATMENT effectiveness, TUMORS, VEINS, VEINS -- Diseases, WARFARIN
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Implementation of targeted interventions to decrease antiretroviral-related errors in hospitalized patients

Purpose. The implementation and effectiveness of targeted interventions aimed at decreasing the frequency of antiretroviralrelated errors in hospitalized patients with human immunodeficiency virus (HIV) are described. Summary. A prospective investigation conducted at the University of North Carolina Hospitals revealed a high rate of antiretroviral-related errors occurring on admission to the hospital and throughout a patient’s hospital stay. The high frequency of errors emphasized the need for targeted interventions aimed at preventing these errors and quickly identifying and resolving errors that do occur. Several interventions aimed at decreasing this error rate were instituted, including the addition of computer alerts for incorrect doses and drug interactions to the pharmacy order-entry system, distribution of an educational pocket-sized card among the staff, addition of commercially available combination antiretroviral products to the hospital formulary, updates of the computerized prescriber-order-entry (CPOE) system to include common dosage defaults, involvement of the infectious diseases consultation service to evaluate prescribed regimens of newly admitted patients with HIV, and daily review of newly initiated antiretroviral regimens by a clinical pharmacist trained in HIV care. A follow-up analysis was conducted after these interventions were implemented to evaluate their effectiveness. Of the 78 patients identified during the postintervention analysis, 12 (15%) had at least one error in their initial drug regimen versus 49 patients (72%) in the preintervention study (p < 0.001). Conclusion. Antiretroviral medication error rates decreased after the implementation of targeted interventions that included distributing an educational pocket-sized card, adding alerts to the pharmacy order-entry system, incorporating default dosages into the CPOE system, and adding combination antiretrovirals to the formulary. [ABSTRACT FROM AUTHOR]

March 1, 2012 Tags: ANTIRETROVIRAL agents, CHEMOTHERAPY, Combination, DATA analysis, DRUG delivery systems, DRUG interactions, DRUG resistance, HUMAN services programs, INFORMATION storage & retrieval systems -- Pharmacy, MEDICATION errors, MEDICINE -- Formulae, ORDER entry, PHARMACISTS, prescriptions, PREVENTION, receipts, SENTINEL health events
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Projecting future drug expenditures–2012

Purpose. Factors likely to influence drug expenditures, drug expenditure trends in 2010 and 2011, and projected drug expenditures for 2012 are discussed. Summary. Data were analyzed to provide drug expenditure trends for total drug expenditures and the hospital and clinic sectors. Data were obtained from the IMS Health National Sales Perspectives database. From 2009 to 2010, total U.S. drug expenditures increased by 2.7%, with total spending rising from $299.2 billion to $307.5 billion. Drug expenditures in clinics grew by 6.0% from 2009 to 2010. Hospital drug expenditures increased at the moderate rate of 1.5% from 2009 to 2010; through the first nine months of 2011, hospital drug expenditures increased by only 0.3% compared with the same period in 2010. The dominant trend over the past several years is substantial moderation in expenditure growth for widely used drugs, primarily due to the ongoing introduction and wide use of generic versions of high-cost, frequently used medications. At the end of 2010, generic drugs accounted for 78% of all retail prescriptions dispensed. Another pattern is substantial increases in expenditures for specialized medications, particularly in the outpatient setting as growth in prescription drug expenditures for clinic-administered drugs consistently outpaces growth in total expenditures. Various factors are likely to influence drug expenditures in 2012, including drugs in development, the diffusion of new drugs, generic drugs, drug shortages, and biosimilars. Conclusion. For 2012, we project a 3-5% increase in total drug expenditures across all settings, a 5-7% increase in expenditures for clinic-administered drugs, and a 0-2% increase in hospital drug expenditures. [ABSTRACT FROM AUTHOR]

March 1, 2012 Tags: ALTERNATIVE medicine, CLINICS, COST control, DRUG approval, DRUG development, DRUGS, ECONOMICSECONOMIC aspects, FORECASTING, GENERIC drugs, HOSPITALS -- Cost of operation, PHARMACISTS
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Optimizing pain relief in a specialized outpatient palliative radiotherapy clinic: contributions of a clinical pharmacist

Purpose. Bone metastases are the most common cause of cancer pain, with palliative radiotherapy (RT) the mainstay of treatment. However, relief from RT may be delayed, incomplete, or short-lived and therefore optimized pharmacologic therapy is essential. Our objective was to describe the contribution of the clinical pharmacist (CP) to an outpatient palliative RT clinic.Methods. The Edmonton Symptom Assessment System, an 11-point scale for measuring nine symptoms, and other validated screening tools were administered, and a medication history performed by the CP. Baseline CP assessment also included opioid toxicity, need for supportive medications, and drug interactions. Anonymized clinical information was collected prospectively and descriptive statistics were compiled including themes of counselling performed by the CP.Results. The CP reviewed 114 patients over 140 clinic visits (01/2007–12/2008). Median age was 68.3 years, 68.4% were male and 36.8% had prostate cancer. All symptoms improved or stabilized in ≥80% by 4 weeks. Median pain score was 6/10 (SD 2.6) at baseline, and 2.1/10 (SD 2.4) by week 4. Average morphine equivalent daily dose was 76.8 mg at baseline and 44.5 mg at week 4. CP assessment included screening for opioid toxicity (87.9%), recommending a change in analgesic (28.9%), and liaison with the community pharmacy (17.1%). Medication counselling took place in 84.3% of visits, on bowel routine (85.6% of the time), opioids (82.2%), and hydration (40.7%).Conclusions. The CP plays a key role in holistic patient assessment and optimization of pharmacologic therapy, contributing to improved symptom control of patients receiving palliative RT.

March 1, 2012 Tags: ANALGESICS, BONE metastasis, BOWEL & bladder training, CANCER pain, DATA analysis -- Software, DESCRIPTIVE statisticsTREATMENT, HEALTH care teams, HOSPITAL pharmacies, HOSPITALS -- Outpatient services, LONGITUDINAL method, MEDICAL care -- Needs assessment, MORPHINE, NARCOTICS, OCCUPATIONAL roles, OUTCOME assessment (Medical care), PAIN -- Measurement, PALLIATIVE treatment, PATIENT education, PERFORMANCE evaluation, PHARMACISTS, QUALITY of life, RETROSPECTIVE studies, SCALES (Weighing instruments), TREATMENT effectiveness
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