Emerging From the COVID-19 Crisis With a Stronger Health Care Workforce.

The COVID-19 pandemic has highlighted the limitations of the current health care workforce. As health care workers across the globe have been overwhelmed by the crisis, oversight entities and training programs have sought to loosen regulations to support ongoing care. Notably, however, workforce challenges preceded the current crisis. Now may be the time to address these underlying workforce challenges and emerge from the COVID-19 pandemic with a stronger health care workforce.Building upon historical exemplars in the context of the current crisis, the authors of this Perspective provide a roadmap to rapidly and safely increase the workforce for COVID-19 and beyond. The authors recommend the following: (1) a comprehensive approach to guide health care workforce development, (2) streamlining transitions to the next level of practice, (3) reciprocity among state licensing boards or national licensure, (4) payment reform to support a strengthened health care workforce, and (5) efforts by employers to ensure the ongoing safety and competence of the bolstered workforce. These steps require urgent collaboration among stakeholders commensurate with the acuity of the pandemic. Implemented together, these actions could address not only the novel challenges presented by COVID-19 but also the underlying inadequacies of the health care workforce that must be remedied to create a healthier society.

Evaluation of a Structured Onboarding Process and Tool for Faculty Members in a School of Pharmacy.

Objective. To develop and assess the usefulness of a structured onboarding process and tool at a school of pharmacy to improve the overall onboarding experience for new faculty members. Methods. An assessment of a previously existing, informal onboarding process was conducted from January 1 to February 28, 2017. A structured onboarding tool was developed based on interviews with nine recently hired faculty members regarding their experiences with this legacy, unstructured onboarding process. Nine faculty members who onboarded while the legacy onboarding process was in place and six faculty members who onboarded after the new, onboarding tool was in place were included in the study. The experience of the pre-tool cohort was compared to that of the post-tool cohort. Results. More positive responses in the post-tool cohort were obtained compared to the pre-tool cohort in regard to timeline, expectations, and mentorship. More negative responses for the post-tool group were observed for communication. Overall utility of the onboarding tool changed from 56% (pre-tool group) to 80% (post-tool group). Free text feedback included recommendations to rearrange tasks throughout the onboarding process; clarifying mentor responsibilities and expectations; and providing an overview of the checklist to new faculty members on day 1. Conclusion. Overall, a structured onboarding process tool improved the onboarding experience for new faculty members. Given the lack of literature regarding a structured onboarding process in the academic setting, further refinement and analysis of the onboarding tool is needed.

Reexamining the Academic Partnerships with Federal Pharmacy: 2018-19 Argus Commission Report.

The Argus Commission examined the history and current status of progressive pharmacy patient care services across several federal branches of government, including the Veterans Administration, Department of Defense, and the U.S. Public Health Service where officers and civilian pharmacists practice in the Indian Health Service, Bureau of Prisons, Area Health Education Centers and other locations. The engagement of pharmacy faculty, students and residents in these practices was assessed. Colleges and schools of pharmacy advocate for the expansion of the capacity for placement of learners in these progressive practices. AACP is encouraged to establish on going collaborations with federal pharmacy leaders to create new opportunities for partnerships that advance patient care, especially for special populations served in these federal programs.

The status of US multi-campus colleges and schools of pharmacy.

OBJECTIVE: To assess the current status of multi-campus colleges and schools of pharmacy within the United States. METHODS: Data on multi-campus programs, technology, communication, and opinions regarding benefits and challenges were collected from Web sites, e-mail, and phone interviews from all colleges and schools of pharmacy with students in class on more than 1 campus. RESULTS: Twenty schools and colleges of pharmacy (18 public and 2 private) had multi-campus programs; 16 ran parallel campuses and 4 ran sequential campuses. Most programs used synchronous delivery of classes. The most frequently reported reasons for establishing the multi-campus program were to have access to a hospital and/or medical campus and clinical resources located away from the main campus and to increase class size. Effectiveness of distance education technology was most often sited as a challenge. CONCLUSION: About 20% of colleges and schools of pharmacy have multi-campus programs most often to facilitate access to clinical resources and to increase class size. These programs expand learning opportunities and face challenges related to technology, resources, and communication.

Medicare-approved drug discount cards and prescription drug prices.

PURPOSE: Prescription drug prices with and without the use of Medicare-approved drug discount card programs (MADDCs) to purchase medications were studied. METHODS: The Medicare.gov Web site was used to determine if the 200 most frequently prescribed drugs in the United States in 2003 were covered by a MADDC. The lowest and highest MADDC prices at local and mail-order pharmacies and the corresponding non-MADDC prices at the same community pharmacies or an Internet pharmacy, respectively, were determined. Wilcoxon signed rank tests were used to determine if there was a difference between non-MADDC medication prices and MADDC prices. RESULTS: Of the top 200 medications prescribed in 2003, 192 (96%) and 189 (94.5%) were covered by at least one MADDC in a local pharmacy or mail-order pharmacy, respectively. Overall, MADDCs saved money compared with purchasing medications without a MADDC (p < 0.001). However, a MADDC resulted in a higher price than the retail non-MADDC price for 61 (31.8%) of the prescription medications at local pharmacies, and using a MADDC at a mail-order pharmacy resulted in a higher price than the Internet pharmacy non-MADDC price for 143 (75.7%) of the drugs. CONCLUSION: MADDC prices for common prescription medications were generally lower than prices when MADDCs were not used. The highest mail-order MADDC prices were often higher than Internet non-MADDC prices.

Comparing renal transplant patients' adherence to free cyclosporine and free tacrolimus immunosuppressant therapy.

BACKGROUND: The purpose of this study is to determine if there is a difference in renal transplant patients' (RTPs) adherence to cyclosporine compared to tacrolimus when medications are supplied free to the RTPs. METHODS: Adult primary RTPs were included in the study if they received a renal transplant at the Medical College of Georgia (MCG) from June 1998 through August 2001 and received their first post-transplant year of follow-up care at MCG and free cyclosporine or free tacrolimus from the MCG outpatient pharmacy. Adherence was estimated by comparing each RTPs' tacrolimus or cyclosporine pharmacy refill records to the prescribed regimen for 12 months after transplant. Patients' cyclosporine and tacrolimus serum concentrations were used to validate adherence. Kaplan-Meier analysis was used to estimate the fraction of RTPs remaining adherent and to compare the mean time RTPs were adherent in each group (cyclosporine vs. tacrolimus). RESULTS: Thirty-three RTPs were included in the study, 25 (76%) received cyclosporine and eight received tacrolimus. The mean time to the first non-adherent month was 8 months post-transplant. At 12-months post-transplant, approximately 42% of the patients remained adherent. A greater percentage of the patients who received tacrolimus remained adherent compared with those who were taking cyclosporine (63% vs. 33%, p < 0.05). Approximately 75% of non-adherent patients were found to have subtarget drug concentrations, and only 24% of adherent patients had subtarget levels (p < 0.01). CONCLUSIONS: When provided free, patients are more adherent to tacrolimus than cyclosporine. Regardless of treatment, intensive efforts to increase adherence should be implemented.

Pharmaceutical manufacturer assistance programs.

BACKGROUND AND OBJECTIVE: While there have been many public discussions concerning Medicare covering outpatient prescription medications, currently, Medicare does not pay for most outpatient prescriptions. Meanwhile, costs associated with prescription medications as well as the number of underinsured patients are rapidly increasing. Many pharmaceutical companies offer assistance programs for patients who require medications but have inadequate financial resources to obtain them. Because patient access to required prescriptions is critical and clinician involvement is necessary for patient enrollment, the purpose of this article is to facilitate awareness of pharmaceutical companies' assistance programs, the availability of such programs, and their enrollment process. METHODS: English-language articles from MEDLINE (1963-2000) and Internet Web pages describing medication assistance programs were reviewed. Data obtained from pharmaceutical companies' medication assistance programs were also included. In addition to general information concerning medication assistance programs, all studies found in the literature search describing the clinical and financial impact of using these programs and data obtained from contacting several medication assistance programs were selected. To determine if an assistance program was available for a medication listed as one of the top 200 medications prescribed in the United States, we contacted the pharmaceutical company that manufactures each medication. RESULTS: Approximately 53% of the top 200 prescribed medications in 1999 were offered through assistance programs to indigent patients. Physician office personnel can obtain medications for eligible patients by completing the enrollment process. CONCLUSION: Pharmaceutical companies' medication assistance programs can be used to reduce individual patient drug expenditures and improve patient outcomes by increasing medication access to those in need.