Substance misuse training in pharmacy education: Results from a pilot study on the integration of an interprofessional experience.

Background: Studies show that pharmacists are unsure in their ability to screen patients for substance abuse. This study evaluates the efficacy of incorporating interprofessional education (IPE) into a substance misuse training program on pharmacy students' learning outcomes in providing screening and counseling for substance misuse. Methods: Pharmacy students from 2019 to 2020 completed 3 substance misuse training modules. Students from the class of 2020 completed an additional IPE event. Both cohorts completed pre- and post-surveys that evaluated knowledge of content and comfort level with patient screening and counseling regarding substance misuse. Paired student t-tests and difference-in-difference analyses were used to evaluate the impact of the IPE event. Findings: Both cohorts (n = 127) showed statistically significant improvement in learning outcomes in providing substance misuse screening and counseling. IPE yielded extremely positive feedback from all students, but its addition to the overall training did not improve learning outcomes. This may be attributed to the differences in baseline knowledge of each class cohort. Conclusion: Substance misuse training successfully improved pharmacy student knowledge and comfort level with providing patient screening and counseling services. Though the IPE event did not improve learning outcomes, qualitative student feedback was overwhelmingly positive and supports the continued incorporation of IPE.

Performance-Based Risk-Sharing Arrangements (PBRSA): Is it a Solution to Increase Bang for the Buck for Pharmaceutical Reimbursement Strategy for Our Nation and Around the World?

Due to the risks involved in not achieving desired health outcomes for the dollar spent on drugs, healthcare decision makers, including payers, providers, drug manufacturers, and patients, need a mechanism to share this financial risk among the involved parties. Performance-based risk-sharing arrangements (PBRSAs) are agreements that can potentially reduce the 'drug lag' in which patients wait for an unknown amount of time until a particular drug is covered under their health plan. In addition, PBRSAs can mitigate the risk of investing heavily in drugs that are ineffective or do not deliver good value or "bang for the buck". This review describes and evaluates PBRSAs for drugs in the USA and juxtaposes to other developed nations (i.e. Germany) that adopted PBRSAs in their healthcare model. There are different types of outcomes-based health schemes, namely conditional coverage, which can be further broken down into coverage with evidence development (CED), conditional treatment continuation (CTC), and performance-linked reimbursement, which includes outcomes guarantees. Both CED and CTC are 'conditional' on the collected evidence of the new drug's effectiveness, offering discount only if the drug delivers desirable results. The outcomes guarantee scheme offers discount or even a full refund if the outcome is less than expected, forcing the drug to meet the expected effectiveness. The USA can follow the German reference pricing model in which the assessment of new drugs is centralized and done collectively by representatives from a group of healthcare decision makers. In any shape or form, PBRSA is a clever mechanism to cope with uncertainty if drug price is scaled appropriately based on value.

Systematic Review and Meta-analysis of Pharmacist-Led Transitions of Care Services on the 30-Day All-Cause Readmission Rate of Patients with Congestive Heart Failure.

BACKGROUND AND OBJECTIVE: A systematic review and meta-analysis were performed to determine the cumulative effect of pharmacist-led transitions of care on the 30-day all-cause readmission rates of patients with congestive heart failure with the objective to isolate and assess the effect of pharmacy intervention to a condition-specific service. Previous studies that review pharmacist-led transitional care services involve multiple condition-specific services or a pharmacy service integrated into the healthcare team that presents complications in interpreting the independent effectiveness of component services by pharmacy professionals. METHODS: A systematic review was conducted using articles identified from MEDLINE, CINAHL, Web of Science, Embase, the Cochrane Library, and clinicaltrials.gov databases for studies on congestive heart failure readmission rates based on transitions of care pharmacist services using detailed inclusion and exclusion criteria. Abstracts were screened for outcome of interest and appropriate transitions of care program structure. Practice and patient characteristics were described and compared to identify current practice trends. A meta-analysis was then performed utilizing previously identified studies from systematic analysis that reported the required data to calculate the effect size. Evidence was reviewed and appraised according to the Newcastle-Ottawa Scale for cohort studies. RESULTS: The database search produced 443 potential articles for inclusion. Six articles were identified for inclusion in the systematic review based on abstract screening. Of the six articles included in the systematic review, three studies met inclusion criteria for a meta-analysis. Two studies in the meta-analysis stated a significant reduction in the 30-day all-cause readmission rate for patients with congestive heart failure, while the third depicted a reduction in readmission that was found to be non-significant. The pooled effect of the included articles found that pharmacist-led transitions of care services for patients with congestive heart failure had an increased odds to have lower all-cause readmission rates of patients with congestive heart failure (odds ratio = 2.19, 95% confidence interval 1.50-3.20). Based on the meta-analysis of three studies, pharmacist-led transitions of care services significantly reduced the odds of 30-day all-cause readmission rates in patients with congestive heart failure compared with standard-of-care discharge protocols. CONCLUSION: Results of the meta-analysis demonstrate the capacity for pharmacist-led transitions of care programs to reduce 30-day all-cause readmission rates in patients with congestive heart failure compared with non-pharmacist discharge care. The financial implications of transitions of care pharmacist involvement have yet to be validated. In general, existing database search results highlight the lack of evidence detailing specific clinical outcomes of pharmacist-led transitions of care services in distinct chronic conditions. Future studies may serve to compare patient-centered outcomes between condition-specific services or across disciplines to provide the most cost-effective delivery of care.

Prescription Drug Price Paradox: Cost Analysis of Canadian Online Pharmacies versus US Medicare Beneficiaries for the Top 100 Drugs.

BACKGROUND AND OBJECTIVES: Despite the introduction of Medicare Part D (MPD) and 2012 Affordable Care Act (ACA), patients have a cost burden due to increases in drug prices. To overcome cost barriers, some patients purchase their medications from Canadian online pharmacies as Canadian prescription drug prices are believed to be lower than US prescription drug prices. The objective of this study was to determine which top 100 Medicare drugs can be imported to the USA legally, and to determine which type of prescription drug would be more beneficial to be purchased from Canadian online pharmacies. Moreover, we also deemed it important to compare MPD beneficiary annual expenses with expenses patients would have when obtaining their prescriptions from Canadian online pharmacies. METHODS: We conducted a cost analysis from a patient perspective. A list of the top 100 Medicare drugs was compiled and information on drug prices was collected from three Canadian online pharmacies and four MPD plans in Virginia. The annual cost of each Medicare drug and percent change between Canadian online pharmacies and MPD were compared. RESULTS: A total of 78 drugs from the top 100 Medicare drugs were included in the final analysis. Seventy-six prescription drugs (97.4%) that could be purchased from Canadian online pharmacies showed a significantly lower average drug price percent change of -72.71% (P < 0.0001). The heart health/blood pressure subgroup had the highest number of drugs that could be purchased from Canadian online pharmacies. CONCLUSION: The majority of prescription drugs can be purchased at lower prices from Canadian online pharmacies when compared to Medicare beneficiaries' potential expenses. Purchasing medications from Canadian online pharmacies may be a viable option to address cost barriers.