Implementing Green Supply Chain Management for Online Pharmacies through a VADD Inventory Model.

Online pharmacies are an important part of the modern healthcare system. They interact with customers through well-designed web interfaces to deliver the healthcare customers need. In addition to well-designed web interfaces, online pharmacies rely on an effective supply chain system to provide medical supplies and services, and especially effective inventory management for supply systems. As green supply chain management (GSCM) becomes increasingly considered by countries, how to develop a sustainable inventory model that takes into account the revenue growth of an online pharmacy while preventing waste and reducing energy costs has become very important. In line with this trend, the study develops a sustainable inventory model that focuses on both economic aspect (profit) and environmental aspect (losses from excessive inventory) within a framework of a single period multi-product inventory model. Specifically, the sustainable inventory model applies the visual-attention-dependent demand (VADD) rate to characterize customer demand in an online trading environment, thereby seeking a profitable marketing strategy and reducing losses due to excessive inventory. Since the complexity of model optimization will drastically increase due to the inclusion of many products in the problem, a Genetic Algorithm (GA) based solution procedure is proposed to increase the feasibility of the proposed model in solving real problems. The sustainable inventory model and the solution procedure are illustrated, compared, and discussed with an online pharmacy example. Additionally, a sensitivity analysis is formulated to study the influence of model parameters on the model solution, the loss of unsold inventory that results in a waste of resources and energy, and the profit of online pharmacies.

REMS pharmacy tasks: The adoption of an innovative electronic support system.

OBJECTIVES: The objective of this study was to evaluate the pharmacy adoption rates of an online Risk Evaluation and Mitigation Strategy (REMS) Pharmacy Portal designed as an alternative for REMS-certified pharmacies to perform mandatory pharmacy dispense confirmations and to assess whether Pharmacy Portal uptake was affected by the pharmacy daily dispense volume. SETTING: REMS-certified pharmacies dispensing lenalidomide (Revlimid), pomalidomide (Pomalyst), or thalidomide (Thalomid). PRACTICE DESCRIPTION: Primarily specialty and hospital pharmacies in the limited distribution network that used the REMS Pharmacy Portal. PRACTICE INNOVATION: A self-service pharmacy portal was developed to allow REMS-certified pharmacies to obtain confirmation numbers instead of calling a Celgene Customer Care Representative (CCR) or using the Interactive Voice Response System (IVR) system. EVALUATION: The numbers of pharmacy dispense confirmations obtained were identified, and the mean percentages by quarter (Q) were calculated from January 2013 through August 2016 for the Pharmacy Portal, Celgene CCR, and IVR. RESULTS: In Q1 2013, the CCR and IVR options were used for 57% and 43% of dispense confirmations, respectively. After the training period, the Pharmacy Portal rapidly became the most used option (67% of confirmations from Q2 2014). By August 2016, data displayed the continued preference for the pharmacy portal (98% of all confirmations) regardless of the daily dispense volume of the pharmacy. As of March 30, 2018, the pharmacy portal continued to be the preferred option for all pharmacies (maintained at 98.5% use). CONCLUSION: There is an overwhelming REMS pharmacy preference to use the pharmacy portal over the IVR and CCR options, irrespective of the pharmacy daily dispense volume. The rapid uptake of the pharmacy portal is most likely attributed to robust and comprehensive 1-on-1 training and support provided by the REMS sponsor to the REMS-certified pharmacies, but also because it might be easier to use than the other options, resulting in reduced REMS burden for the pharmacy.

Chat-based telepharmacy in Denmark: design and early results.

OBJECTIVES: Following the introduction of a nationwide online telepharmacy chat-service in Denmark in the spring of 2012, offering free counselling to all Danish citizens, we aimed to investigate the types of enquiries that are made to the telepharmacy. METHODS: We extracted 500 consecutive chat transcripts and categorised them in four categories: drug-related, symptom, technical and other. These categories were further divided into 28 prespecified subcategories. After the categorisation of the 500 transcripts, 7 new subcategories were added and the material was reanalysed. For drug-related enquiries, the drug in question was registered according to the anatomical-therapeutic-chemical system developed by World Health Organization. Veterinary and empty (nonresponding) enquiries were excluded. KEY FINDINGS: Four hundred seventy-six eligible enquiries were identified and categorised. The enquiries were found to be diverse: 170 enquiries (35.7%) were drug-related, 124 (26.1%) were technical in nature, 91 (19.1%) were related to symptoms and 91 (19.1%) of the enquiries were categorised as other. The most common drug class was 'drugs related to the genitourinary system and sex hormones'. Only 50 (10.5%) of the enquiries happened in connection with an actual purchase at the online pharmacy. Of all enquiries, 28.6% led to a referral to a medical doctor. Of the customers, 89.2% were satisfied with the online counselling. CONCLUSION: The diverse enquiries require professional chat operators with broad experience. Some subjects are overrepresented when compared with regular pharmacy counselling and should receive special attention. Continued monitoring is considered essential.

Feasibility and acceptance of a pharmacist-run tele-oncology service for chemotherapy-induced nausea and vomiting in ambulatory cancer patients.

BACKGROUND: The use of telemedicine for cancer patients is limited, particularly in Asia. These patients need to be monitored because more are being treated as outpatients, so that any treatment-related side effects can be managed. We assessed the feasibility and acceptance of a pharmacist-run tele-oncology service to monitor chemotherapy-induced nausea and vomiting (CINV) in ambulatory cancer patients. PATIENTS AND METHODS: A single-center, prospective study was conducted at a local cancer center. Patients' CINV symptoms were monitored through short message service (SMS) for 5 days post-chemotherapy. Feasibility was measured by patients' adherence to the service, patient satisfaction, and number of pharmacist interventions. Acceptance was measured by the accrual rate. RESULTS: The accrual rate was 37.6% (68/181 patients). Sixty patients (median age, 49.5 years) completed the study. Overall adherence was 73.3%. The majority (90.0%) were comfortable with the duration of SMS monitoring, especially adherent patients (95.5% versus 75.0%, p=0.038). Over half (61.7%) found the SMS advice useful. Twenty-two intervention calls were made by pharmacists for uncontrolled CINV. CONCLUSIONS: A pharmacist-run tele-oncology service for real-time monitoring of CINV is feasible in ambulatory cancer patients. Incorporating the monitoring of other side effects will enhance its value and acceptance by patients for post-chemotherapy symptom management.

Slow progress on meeting hospital safety standards: learning from the Leapfrog Group's efforts.

In response to the Institute of Medicine's To Err Is Human report on the prevalence of medical errors, the Leapfrog Group, an organization that promotes hospital safety and quality, established a voluntary hospital survey assessing compliance with several safety standards. Using data from the period 2002-07, we conducted the first longitudinal assessment of how hospitals in specific cities and states initially selected by Leapfrog progressed on public reporting and adoption of standards requiring the use of computerized drug order entry and hospital intensivists. Overall, little progress was observed. Reporting rates were unchanged over the study period. Adoption of computerized drug order entry increased from 2.94 percent to 8.13 percent, and intensivist staffing increased from 14.74 percent to 21.40 percent. These findings should not be viewed as an indictment of Leapfrog but may reflect various challenges. For example, hospitals faced no serious threats to their market share if purchasers shifted business away from those that either didn't report data or didn't meet the standards. In the absence of mandatory reporting, policy makers might need to act to address these challenges to ensure improvements in quality.

Impact of an online prescription management account on medication adherence.

OBJECTIVES: To assess medication adherence rates of patients utilizing an online prescription management account compared with nonusers. STUDY DESIGN: A retrospective analysis was conducted using de-identified pharmacy claims data from a pharmacy benefit manager covering the period from April 1, 2009, to March 31, 2011. Patients who were continuously eligible throughout the study period and that had at least 1 prescription fill for any of the 8 therapeutic groups examined in the study were selected for inclusion. METHODS: Adherence was assessed by measuring the proportion of days covered (PDC). Propensity score matching was utilized to minimize differences in age, gender, chronic condition score, copay, household income, and urban locality between the users and nonusers groups. Results were reported for all therapeutic groups combined, as well as by individual therapeutic group. RESULTS: Overall, patients utilizing the online account had a significantly higher weighted average PDC (73.19% vs 61.64%, P <.0001). Users also had a higher average PDC for each individual therapeutic group, although the beta-blocker group was not statistically significant. The percentage of patients achieving an average PDC of >80% was also found to be greater in the users group across each therapeutic group and overall. CONCLUSIONS: Patients who utilized an online prescription management account had higher rates of medication adherence as compared with nonusers. Additional studies are needed to assess which specific components of the prescription management account have the biggest impact on adherence.