Drugs supply and pharmaceutical care management practices at a designated hospital during the COVID-19 epidemic.

The coronavirus disease-19 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus that was first detected at the end of December 2019. The epidemic has affected various regions of China in different degrees. As the situations evolve, the COVID-19 had been confirmed in many countries, and made a assessment that it can be characterized as a pandemic by the World Health Organization on March 11, 2020. Drugs are the main treatment of COVID-19 patients. Pharmaceutical service offers drug safety ensurance for COVID-19 patients. According to COVID-19 prevention and control policy and requirements, combined with series of diagnosis and treatment plans, pharmacists in the first provincial-level COVID-19 diagnosis and treatment unit in Jilin Province in Northeast China have established the management practices of drug supply and pharmaceutical care from four aspects: personnel, drugs supply management, off-label drug use management and pharmaceutical care. During the outbreak, the pharmaceutical department of THJU completed its assigned workload to ensure drug supply. So far, no nosocomial infections and medication errors have occurred, which has stabilized the mood of the staff and boosted the pharmacists' confidence in fighting the epidemic. For the treatment of COVID-19, pharmacists conducted adverse reaction monitoring and participated in the multidisciplinary consultation of COVID-19. Up to now, the COVID-19 patients admitted to THJU have not shown any new serious adverse reactions and been cured finally. The hospital pharmacy department timely adjusted the work mode, and the formed management practices is a powerful guarantee for the prevention and control of the COVID-19 epidemic. This paper summarized the details and practices of drug supply and pharmaceutical services management to provide experience for the people who involving in COVID-19 prevention and contain in other abroad epidemic areas.

Milestones in managed care pharmacy.

Managed care pharmacy has a relatively short history, but one that is defined by significant achievements. Since the late 1960s, managed care pharmacists have applied their unique skills to formulary management, clinical programs, benefit design, and contract negotiations to support patient access to life-saving therapies, while also ensuring cost-effective use of limited health care resources. Key milestones include establishing the pharmacy benefit as an essential component of the U.S. health care system, launching the Medicare Part D program, and expanding medication therapy management services. The year 2020 brings another milestone-the 25th anniversary of AMCP's flagship publication, the Journal of Managed Care + Specialty Pharmacy. This year also serves as an inflection point. As managed care pharmacy professionals prepare for change and the challenges ahead-including the imperative to address the rising costs of health care and health disparities-the use of evidence, utilization management strategies, and innovation will support our continued success. DISCLOSURES: No funding supported the writing of this commentary. The authors have nothing to disclose.

Managed Care Pharmacy Research on Inappropriate Opioid Use Interventions.

DISCLOSURES: No funding contributed to the writing of this commentary. The authors have nothing to disclose.

A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data.

PURPOSE: Public and private payers have implemented benefit limitations to reduce high-risk opioid prescriptions. The effect of these policies on the increase of out-pocket payment is unclear. To understand this gap, we compared the discrepancies in trends between opioid prescription fills vs claims among Medicaid beneficiaries. METHODS: Data from the Oregon Prescription Drug Monitoring Program (PDMP) and Oregon Medicaid administrative claims were used to identify Medicaid beneficiaries 18 years and older enrolled at least one full month from 2015 to 2017. Generalized linear models assessed the trends in the monthly rates of opioid PDMP prescription fills and pharmacy claims per 1000 eligible members. Rates by morphine equivalent dose (MED) tier (<50, 50-89, 90-120, >120 MED) and co-prescribed opioid and benzodiazepine were also assessed. RESULTS: During the study period, an average of 495 355 Medicaid members had 2 797 054 opioid PDMP fills and 2 472 155 opioid Medicaid pharmacy claims. Study participants had 15.4 (95% confidence interval [CI] 13.6 to 17.0; P < .001) more prescriptions per 1000 member per month in the PDMP data (114.1 [SD 7.4]) compared with the Medicaid claims data (98.7 [SD 7.9]). Similarly, there were 1.9 more co-occurring opioid/benzodiazepine prescriptions per 1000 members per month observed in the PDMP data than the Medicaid claims data (95% CI 1.7 to 2.1; P < .001). At each MED tier, the PDMP fills were consistently higher than the claims (P < .001). CONCLUSIONS: Higher rate of fills in the PDMP compared to pharmacy claims suggests that there may be an increasing trend of out-of-pocket payment among Medicaid beneficiaries.

Strategies to promote access to medications during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, vulnerable and older people with chronic and complex conditions have self-isolated in their homes, potentially limiting opportunities for consultations to have medications prescribed and dispensed. OBJECTIVE: The aim of this article is to describe initiatives to ensure ongoing access to medications during the COVID-19 pandemic. DISCUSSION: Cooperation between wholesalers and purchase limits in pharmacies have helped to ensure supply of essential medications. Therapeutic substitution by pharmacists is permitted for specific products authorised by the Therapeutic Goods Administration. Prescribers are permitted to issue digital image prescriptions, and implementation of electronic prescribing has been fast-tracked. Expanded continued dispensing arrangements introduced during the bushfire crises have been temporarily extended. Pharmacists are permitted to provide medication management reviews via telehealth. A Home Medicines Service has been introduced to facilitate delivery of medications to people who are vulnerable or elderly. Anticipatory prescribing and medication imprest systems are valuable for access to end-of-life medications within residential aged care.

Moving Pharmacy Benefits from Nice to Have to Essential Benefits.

DISCLOSURES: No funding supported the writing of this commentary. The authors have nothing to disclose.

Improved time to treatment failure and survival in ibrutinib-treated malignancies with a pharmaceutical care program: an observational cohort study.

Ibrutinib treatment has been shown to increase survival in patients with B cell malignancies. Real-life data suggest a large part of discontinuations are due to toxicities, impairing ibrutinib efficacy. We aimed to assess the impact of a pharmaceutical care program on the efficacy and safety of ibrutinib. This single-center, cohort, observational study enrolled patients with B cell malignancies. Patients were either assigned to the program or to receive usual care, based on physician decision. The program was conducted by clinical pharmacists specializing in oncology and included patient education for management of toxicities, adherence monitoring, interventions to reduce drug-drug interactions, and follow-up of transition from hospital to community. Between February 2014 and May 2017, we enrolled 155 patients, including 42 (27%) who were allocated to the program group and 113 (73%) to the usual care group. The effect of the program was beneficial in terms of time to treatment failure (p = 0.0005). The 30-month progression-free and overall survivals were significantly superior in the program group (respectively p = 0.002 and p = 0.004). Grade 3 or higher adverse events occurred more frequently for patients in the usual care group (15%) than program group (8%). A pharmaceutical care program provides a personalized environment for outpatient monitoring and control of the key risks associated with oral anticancer agents. This study shows evidence that management of ibrutinib treatment by clinical pharmacists results in significant improvement in survival and better tolerance than usual care.

Framework for Pharmacy Services Quality Improvement-A Bridge to Cross the Quality Chasm.

OBJECTIVE: To review the literature on the subject of quality improvement principles and methods applied to pharmacy services and to describe a framework for current and future efforts in pharmacy services quality improvement and effective drug therapy management. BACKGROUND: The Academy of Managed Care Pharmacy produced the Catalog of Pharmacy Quality Indicators in 1997, followed by the Summary of National Pharmacy Quality Measures in February 1999. In April 2002, AMCP introduced Pharmacy's Framework for Drug Therapy Management in the 21st Century. The Framework documents include a self-assessment tool that details more than 250 specific "components" that describe tasks, behaviors, skills, functions, duties, and responsibilities that contribute to meeting customer expectations for effective drug therapy management. FINDINGS: There are many opportunities for quality improvement in clinical, service, and cost outcomes related to drug therapy management. These may include patient safety; incidence of medical errors; adverse drug events; patient adherence to therapy; attainment of target goals of blood pressure, glucose, and lipid levels; risk reduction for adverse cardiac events and osteoporotic-related fractures; patient satisfaction; risk of hospitalization or mortality; and cost of care. Health care practitioners can measure improvements in health care quality in several ways including (a) a better patient outcome at the same cost, (b) the same patient outcome at lower cost, (c) a better patient outcome at lower cost, or (d) a significantly better patient outcome at moderately higher cost. Measurement makes effective management possible. A framework of component factors (e.g., tasks) is necessary to facilitate changes in the key processes and critical factors that will help individual practitioners and health care systems meet customer expectations in regard to drug therapy, thus improving these outcomes. CONCLUSIONS: Quality improvement in health care services in the United States will be made in incremental changes that rely on a structure-process-outcome model. The structure is provided by evidence created from controlled randomized trials and other studies of care and system outcomes that are based on the scientific method. The process portion is created by the application of evidence in the form of clinical practice guidelines, clinical practice models, and self-assessment tools such as Pharmacy's Framework for Drug Therapy Management. Incremental changes in structure and process will result in the desirable outcome of meeting customer needs for more effective drug therapy and disease management. DISCLOSURES: Authors Richard N. Fry and Steven G. Avey are employed by the Foundation for Managed Care Pharmacy, a nonprofit charitable trust that serves as the educational and philanthropic arm of the Academy of Managed Care Pharmacy; author Frederic R. Curtiss performed the majority of work associated with this manuscript prior to becoming editor-in-chief of the Journal of Managed Care Pharmacy. This manuscript underwent blinded peer review and was subject to the same standards as every article published in JMCP.

Traversing the Quality Chasm: Revisiting the Framework for Pharmacy Services Quality Improvement.

DISCLOSURES: No funding supported the writing of this reflection. The authors have nothing to disclose.

Global oncology pharmacy response to COVID-19 pandemic: Medication access and safety.

Response, action, and adaptation of the way health services are delivered will impact our ability to provide optimized and continuity of care while acting within resource constraints imposed by COVID-19. Care for patients with cancer is particularly important given increased infection rates and worse outcomes from COVID-19 in this patient population, as well as potential adverse outcomes if treatment pathways need to be compromised. In this commentary, we provide a global oncology pharmacy perspective (including both developed and developing nations) on how COVID-19 has impacted access to and delivery of cancer therapies. This perspective was prepared by the International Society of Oncology Pharmacy Practitioners, with input from national and regional oncology pharmacy practice groups (42 practice leaders from 28 countries and regions) who contributed to a snapshot survey between 10 and 22 April 2020. Specifically, we highlight challenges related to safe handling of hazardous drugs and maintaining high-quality medication safety standards that have impacted various stakeholders.

The Impact of the Pharmaceutical Care Management Model of Hepatitis C Medications on the Cost at Health Insurance Level.

OBJECTIVE: The aim of this study is to evaluate the impact of adopting a pharmaceutical care model on clinical outcomes, patient satisfaction, and cost at a health payer level. METHODS: All patients with hepatitis C virus (HCV) who were insured by Bupa Arabia, with a direct-acting antivirals prior authorization drug request between April 2015 and October 2018 were included in this retrospective quasi-experimental study. The clinical outcome was the achievement of a sustained virologic response at least 12 weeks from end of treatment. Economic and patients' satisfaction outcomes were included in this study. The differences in cost of treatment was analyzed by using the paired t test. Stata statistical software package (StataCorp, College Station, TX) was used for data analysis. RESULTS: A total of 371 patients were enrolled in this program of which 74% (n = 273) required clinical intervention. Among those, HCV treatment was modified for 64%. The overall cure rate was 97% among 267 patients for which sustained virologic responses were available. The results of the paired t test show that there was a 38% reduction in the mean direct cost of medications before and after intervention (95% confidence interval, 33%-43%; P<.001) and the calculated patients' satisfaction was 98%. CONCLUSIONS: A structured pharmaceutical care program for HCV patients can guide the use of specialty medications to achieve optimal clinical outcomes, with lower expenditures and high patients' satisfaction. We can conclude that healthcare insurance can play a key role in managing specialty pharmaceuticals like HCV medications. Because this is a preliminary study, further studies are needed in an experimental design to strengthen the evidence behind the effectiveness of such a program.

Pharmaceutical services in nursing homes in Spain.

OBJECTIVE: To describe the current situation regarding the specialized pharmaceutical service provision in nursing homes in Spain,  from a healthcare perspective reflecting activity, care and services  provided. METHOD: Observational, cross-sectional, multicenter study conducted between February-June 2018 through a survey aimed at all  Hospital Pharmacy Units in Spain. Once the initial version was assessed  by twelve evaluators whose healthcare assistance work were related to  nursing homes, an electronic form was designed, consisting on 10  dimensions and 66 questions. A piloting was carried out by six nursing  homes pharmacists. The results were analyzed descriptively. Results: The overall response rate was 29.7% (113 out of 380). Out of  all studied hospital pharmacy units, 46.0% (n = 52) served nursing  homes (9 as Nursing Homes Pharmacy Department) whose  characteristics defined a profile of pharmacy unit at hospital, public  ownership, consolidation in this activity, with great variability in the  number of centers and patients to be attended by service, and with the  pharmacist's partial dedication. In 51.3% of cases, nursing homes  professionals were represented at pharmacy and therapeutic  committees, while 38.5% were from pharmacy services who  participated in the selection of medical devices. Also, 67.4% performed  an integral management of the therapy. The study has also shown that  34.6% counted on assisted electronic prescription, while 88.5%  performed a pharmaceutical validation of the prescription prior to  dispensing, which in 71.2% of cases consisted of individualized unit  doses. It was found that 42.3% performed a third-level treatment  comprehensive review, and 25.0% participated in the interdisciplinary  nutritional assessment. It also showed that 34.6% actively participated  in either comprehensive geriatric assessment, or clinical cases in  interdisciplinary teams, and 46.2% counted on programs for the safe  use of medicines. CONCLUSIONS: The specialized pharmaceutical care at nursing homes is a reality, although it presents important differences in essential  aspects for the quality of the assistance provided. It is necessary to go  in-depth on the care model to be developed, as well as having a greater  involvement of pharmacy services to achieve a comprehensive and  person-centered care.

Objetivo: Describir la situación actual de la prestación farmacéutica  especializada en centros sociosanitarios en España desde una  perspectiva asistencial reflejando la actividad, la atención y los servicios  prestados.Método: Estudio observacional, transversal, multicéntrico realizado  entre febrero y junio de 2018 mediante encuesta dirigida a todos los  servicios de farmacia hospitalaria de España. Una vez valorada la  versión inicial por 12 evaluadores cuya labor asistencial estaba  relacionada con centros sociosanitarios, se diseñó un formulario  electrónico que constó de 10 dimensiones y 66 preguntas, y se realizó  un pilotaje por seis farmacéuticos de centros sociosanitarios. Los  resultados se analizaron de forma descriptiva.Resultados: La tasa de respuesta global fue del 29,7% (113 de 380). El 46,0% (n = 52) atendían centros sociosanitarios (9 como  servicios de farmacia de centros sociosanitarios) cuyas características  concretaron un perfil de servicio de farmacia de hospital, titularidad  pública, consolidado en esta actividad, con gran variabilidad en número  de centros y pacientes atendidos por servicio, y con dedicación parcial  del farmacéutico. En el 51,3%, las comisiones de farmacia y terapéutica  tenían representación de profesionales de los centros  sociosanitarios, y el 38,5% de los servicios de farmacia participó en  selección de productos sanitarios. El 67,4% realizó una gestión integral  del tratamiento. El 34,6% disponía de prescripción electrónica asistida,  el 88,5% realizó una validación farmacéutica de la prescripción previa a  la dispensación que, en el 71,2% fue en dosis unitaria individualizada. El  42,3% llevó a cabo una revisión integral del tratamiento de nivel 3 y  el 25,0% participó en la valoración nutricional interdisciplinar. El 34,6%  participó activamente en la valoración geriátrica integral o de casos  clínicos en los equipos interdisciplinares y el 46,2% disponía de  programas para el uso seguro de los medicamentos.Conclusiones: La atención farmacéutica especializada en los centros sociosanitarios es una realidad, aunque presenta diferencias importantes en aspectos esenciales para la calidad de la asistencia prestada. Es necesario profundizar en el modelo asistencial a desarrollar y en una mayor implicación de los servicios de farmacia para lograr una atención integrada y centrada en la persona.

Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation.

INTRODUCTION: Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. METHODS: This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. RESULTS: Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0-109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. CONCLUSION: Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.

Description of a pharmacist-led diabetes prevention service within an employer-based wellness program.

OBJECTIVES: To describe a pharmacist-led diabetes prevention service piloted within an employer-based wellness program. PRACTICE DESCRIPTION: A pharmacist-led ambulatory care clinic within a school of pharmacy that provides wellness services to university employees. PRACTICE INNOVATION: Implementation of a diabetes prevention service using opportunistic A1C screening within a biometric screening program. Patients with a prediabetes-level A1C from July 2016 to March 2019 were invited to participate in the National Diabetes Prevention Program (NDPP). EVALUATION: Comparison of baseline characteristics of participants with normal and elevated A1C. Evaluation of participation in the NDPP and changes in clinical values at the subsequent biometric screening appointment for individuals with a prediabetes-level AlC. RESULTS: A1C testing of 740 individuals identified 69 participants (9.3%) with a prediabetes-level A1C and 7 (1.0%) with a diabetes-level A1C. Compared with those with a normal A1C (< 5.7%), participants with an elevated A1C were more likely to be older, nonwhite, obese, and physically inactive, to have a sibling with diabetes, higher random blood sugar (RBS), lower high-density lipoprotein (HDL), and more likely to have hypertension. Twelve patients participated in the NDPP, although most attended only 1 session. Attenders had a significantly lower baseline weight and body mass index (BMI). There were no significant differences in the changes in A1C, BMI, weight, RBS, or HDL between attenders and nonattenders approximately 1 year later. CONCLUSION: This pilot demonstrated that opportunistic A1C testing could be incorporated into an ambulatory care clinic within a pharmacist-led employer-based wellness program. Uptake and retention of the NDPP were poor. Barriers to NDPP participation need to be investigated and addressed to improve service impact.

A pharmacist-managed cardiovascular risk-reduction clinic for individuals experiencing serious mental illness.

OBJECTIVES: This retrospective analysis sought to: (1) characterize a cardiovascular risk-reduction clinic (CVRRC) patient population with serious mental illness (SMI); (2) analyze clinical outcomes of CVRRC patients over a 2-year period; and (3) compare outcomes for individuals prescribed different antipsychotic treatments in the CVRRC patient population over a 2-year period. EVALUATION METHODS: In 2016, A pharmacist-managed CVRRC was implemented within a primary care clinic for patients with SMI. The CVRRC operates under a collaborative practice agreement allowing the pharmacist to initiate and change medications and order laboratory tests. Baseline data collected included demographic information, referring provider, tobacco use, and 10-year atherosclerotic cardiovascular disease risk. Data collected at subsequent visits included date of visit, A1C, estimated average glucose (eAG), blood pressure, weight, body mass index, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, statin and dose, tobacco use, amount smoked, and current antipsychotic treatment. Number of times that treatment for diabetes was initiated or intensified by the pharmacist or primary care provider was also collected. IMPACT OF INNOVATION: A total of 101 patients were referred to the CVRRC over the 2-year period. Of these, 81 (80.2%) had at least 1 subsequent visit and were included in the A1C analysis. CVRRC patients had a statistically significant improvement in A1C over time. Mean A1C decreased by an increment of 0.06% for each month increase in follow-up time (P < 0.0001). There was no significant difference in A1C values between patients on different antipsychotic treatments (P = 0.74). CONCLUSION: The pharmacist-managed CVRRC demonstrated beneficial outcomes for individuals diagnosed with diabetes and SMI. Results provide promising evidence supporting future larger studies to confirm these findings. Considering the morbidity and mortality disparities for individuals with SMI, health care organizations should consider similar models to improve diabetes outcomes.

Pharmacist-driven multidisciplinary pretreatment workup process for hepatitis C care: A novel model for same-day pretreatment workup.

OBJECTIVES: The objective is to describe and quantify the impact of a novel practice model for pharmacist involvement in care coordination and patient education in hepatitis C virus (HCV) care. SETTING: This practice model was implemented in the gastroenterology clinic at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana. PRACTICE DESCRIPTION: Traditional pretreatment workup for HCV requires multiple on-site appointments to complete imaging and laboratory assessments and for provider and social work appointments. High pretreatment time burden and increasing psychosocial complexity of the patient population present significant barriers to HCV eradication. Patients frequently miss appointments, and each on-site visit creates a separate opportunity for patients to be lost to follow-up. PRACTICE INNOVATION: The pharmacist-driven multidisciplinary pretreatment workup process was launched by HCV pharmacists to mitigate barriers. Patients complete the pretreatment evaluation process, which includes same-day pharmacy education, provider visit, social work assessment, FibroScan, and laboratory assessments, in approximately 2.5 hours. EVALUATION: Forty-six patients who completed the pharmacist-driven multidisciplinary pretreatment workup process versus 235 patients who completed traditional workup were analyzed for time from date of HCV consultation placement to treatment start and time from most recent HCV provider visit to treatment start. RESULTS: From time of HCV consult entry to date of treatment start, patients were initiated on HCV treatment in an average of 42.2 ± 7.5 days and 184.1 ± 27.6 days (P = 0.0001) within the intervention and traditional workup groups, respectively. A decreased time from most recent HCV provider visit to treatment initiation was noted between groups with 38.2 ± 7.1 days and 54.7 ± 3.6 days (P = 0.04) in the intervention and traditional workup groups, respectively. CONCLUSION: The pharmacist-driven multidisciplinary pretreatment workup process is an effective way to engage patients and decrease time to treatment initiation. This model could be replicated in other practice settings, especially those challenged by multi-step care coordination.

Pharmaceutical care in the neonatal intensive care unit: Perspectives of Polish medical and pharmacy students.

INTRODUCTION: The concepts of ward-based pharmaceutical care as well as collaborative practice are still relatively novel in Poland, particularly in specialty areas of practice such as the neonatal intensive care unit (NICU). The purpose of this study was to identify the opinions and perceptions of Polish medical and pharmacy students towards the provision of pharmaceutical care services in the NICU as well as pharmacist integration into the ward-based multi-disciplinary NICU treating team. METHODS: A cross-sectional, mixed-method survey was distributed among medical and pharmacy students at a large Polish medical university. RESULTS: A total of 147 students completed the survey (74 pharmacy and 73 medical). Overall, there were statistically significant differences between the perspectives of medical and pharmacy students towards the provision of pharmaceutical care services in the NICU. For 11 out of 15 proposed clinical roles, a significantly lower proportion of medical students (M) agreed that pharmacists should perform these in the NICU compared to pharmacy students (P). These roles included participation in ward rounds (P = 82.4%, M = 38.4%, p < 0.001), therapeutic drug monitoring (P = 98.6%, M = 78.1%, p < 0.001), and monitoring total parenteral nutrition (P = 87.8%, M = 37%, p ≤ 0.001). CONCLUSIONS: Further investigation is needed to develop educational strategies directed at clinical, patient-centered, collaborative roles, particularly for specialty areas of practice such as the NICU, that have the potential to facilitate the provision of a more advanced and comprehensive level of pharmaceutical care.