Impacto da unitarização de ceftazidima + avibactam em um hospital público universitário durante a pandemia de COVID-19 / Impact of ceftazidime + avibactam unitarization in a university public hospital during the COVID-19 pandemic

Introdução: A pandemia de COVID-19 fez aumentar a demanda de medicamentos utilizados em hospitais, como a Ceftazidima + Avibactam. Nesse contexto, a Central de Misturas Intravenosas (CMIV) de um hospital público universitário passou a unitarizar as doses prescritas. O objetivo deste trabalho foi avaliar o impacto da unitarização no consumo deste antibacteriano de alto custo em um hospital público universitário. Métodos: Trata-se de uma análise farmacoeconômica de custos diretos, sobre a utilização de frascos-ampola de Ceftazidima + Avibactam no período de 01/07/2020 a 31/05/2021. Foram unitarizadas todas as doses que correspondiam a uma fração da dose total do frasco-ampola, em Cabine de Segurança Biológica classe II B2. Os frascos-ampola foram utilizados à exaustão, através do compartilhamento e organização dos horários de manipulação. Resultados: O número total de preparos realizados pela CMIV do referido hospital no período foi de 837. O consumo projetado sem a centralização dos preparos seria de 837 (um frasco por dose). Entretanto, o consumo real foi de 437 frascos. A eficiência de unitarização foi de 101%, com economia real de 400 frascos (R$ 244.832,00) para a instituição. Conclusão: A pandemia de COVID-19 sobrecarregou os sistemas de saúde do mundo todo, sendo que a atuação farmacêutica foi fundamental para garantir o acesso aos medicamentos essenciais. A CMIV assumiu a unitarização da Ceftazidima + Avibactam, antibiótico em risco de desabastecimento, gerando um consumo 47,8% menor, contribuindo para o acesso deste medicamento de forma ininterrupta durante os 11 meses avaliados na referida instituição.

Introduction: COVID-19 pandemic has increased the demand for drugs used in hospitals, such as Ceftazidime + Avibactam. In this context, the Central of Intravenous Admixtures (CMIV) of a public university hospital started to unitarize the prescribed doses. The objective of this study was to evaluate the impact of unitarization on the consumption of this high-cost antibacterial in a public university hospital. Methods: This is a pharmacoeconomic analysis of direct costs, on the Ceftazidime + Avibactam vials use, in the period from 07/01/2020 to 05/31/2021. All doses that corresponded to a fraction of the entire vial were unitarized in a Class II B2 Biological Safety Cabin. The vials were used to exhaustion, by sharing them, and organizing the manipulation schedules. Results: The total number of preparations made by the CMIV of that hospital in the period was 837 doses. The projected consumption would be 837 vials (one vial per dose). However, the actual consumption was 437 vials. The unitarization efficiency was of 101%, with real savings of 400 vials (R$ 244,832.00) for the institution. Conclusion: COVID-19 pandemic has overburdened health systems around the world, and pharmaceutical actions have been fundamental to guaranteeing access to essential medicines. CMIV took over the unitarization of Ceftazidime + Avibactam, an antibiotic at risk of shortages, leading to a 47.8% lower consumption, contributing to uninterrupted access to this drug during the 11 months evaluated at that institution.

Years of Rampant Expansion Have Imposed Darwinian Survival-of-the-Fittest Conditions on US Pharmacy Schools.

The number of applicants to US pharmacy schools has been declining since 2013, leading to a national enrollment crisis. Enrollment challenges threaten the viability of many pharmacy programs. Some schools are better equipped than others to confront the risk of having to downsize or close, creating survival-of-the-fittest conditions. Four potential risk factors have been identified based on how applicants might perceive the comparable value of respective programs. Schools with lower risk are public, established before 2000, located within an academic health center, and traditional (ie, four-year) programs. The Academy cannot sustain more than 140 schools much longer. Market forces are establishing a new equilibrium between the number of graduates and the availability of pharmacist jobs. As more jobs become available, more applicants will apply. Until then, the fittest Doctor of Pharmacy programs will thrive, while others might have to downsize to survive, and the weakest will be at risk of extinction.

Relationship between the number of hospital pharmacists and hospital pharmaceutical expenditure: a macro-level panel data model of fixed effects with individual and time.

BACKGROUND: The rapid increase in pharmaceutical expenditure (PE) has been a main problem of global healthcare reform for decades. Previous studies demonstrated that pharmacists play an indispensable role in controlling PE, but macro-research evidence is scarce. Exploring the role of pharmacists from a macro-perspective is essential for pharmacy source allocation with an advantage of extensive applicability over regions. This study aimed to explore the relationship between the number of hospital pharmacists and hospital PE and to provide a macro-perspective evidence to curb the increasing PE and decline unnecessary medications. METHODS: Data were extracted from China Health Statistics Yearbook from 2011 to 2018. A panel dataset with 31 provinces from 2010 to 2017 was constructed. Amongst them, 'Number of hospital pharmacists per 1 million of population' (HLPT) was selected as an independent variable, 'Per visit of hospital outpatient pharmaceutical expenditure' (OTPE) and 'Per capita of hospital inpatient pharmaceutical expenditure' (ITPE) were selected as dependent variables, and 'Number of hospital physicians per 1 million of population' (HLPN) and 'Drug price index' (DPI) were applied as control variables. Fixed-effect panel data analysis was performed to evaluate the relationship between the number of hospital pharmacists and hospital PE. RESULTS: HLPT had a significant and negative relationships with OTPE (ß1 = - 0.0893, p = 0.0132) and ITPE (ß1 = - 4.924, p < 0.001). Considering the control variables, the significant and negative relationships with HLPT and OTPE remained unchanged (ß1 = - 0.141, p < 0.001; ß1 = - 4.771, p < 0.001, respectively), indicating that an increase in hospital pharmacist per 1 million of population led to a decrease of ¥474 million ($67.4 million) OTPE and ¥902 million ($128 million) ITPE in 2017. Overall, in 2017, an increase of 1 hospital pharmacist led to a decrease of approximately ¥1 million ($142 thousands) hospital PE nationwide. CONCLUSION: This study confirmed the negative relationship between hospital pharmacists and hospital PE, indicating that hospital pharmacists might play a significant role in controlling PE. Pharmacists were encouraged to participate in more drug-therapy-related activities, such as medication reconciliation.

Expansion of clinical pharmacist positions through sustainable funding.

PURPOSE: Expansion of clinical pharmacist positions through sustainable funding is described. SUMMARY: The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences was awarded a 2-year program grant to establish an integrated clinical pharmacy program for underserved residents in family health centers in northeastern Colorado. The grant enabled the hiring of 2 bilingual, full-time, board-certified, postgraduate year 2-trained clinical pharmacists to initiate comprehensive clinical pharmacy services. Clinical pharmacy services for diabetes, hypertension, and dyslipidemia management were provided during direct patient care visits using collaborative drug therapy management protocols to facilitate comprehensive medication management. Initial visits lasted 1 hour, and follow-up visits lasted 30 minutes. In addition, clinical pharmacists provided point-of-care consultations for patients seeing other healthcare providers. All patient encounters and consultations were documented in the electronic health record. Success of the clinical pharmacy program was evaluated based on the achievement of goal blood pressure values, glycosylated hemoglobin values, and low-density-lipoprotein cholesterol levels. Pharmacists' involvement in patient care activities led to improvements in all of these clinical outcomes. This coincided with unique funding opportunities with regional accountable care organizations that sought to demonstrate improved patient care in an expansion population. As a result, 2 grant-funded clinical pharmacist positions in 2 community health clinics were converted into 4 faculty positions in 5 community health centers funded by regional accountable care organizations. CONCLUSION: Collaboration with accountable care organizations resulted in the successful funding of ambulatory care clinical pharmacy services. These services resulted in improved chronic disease control and provider satisfaction.

Service provision in the wake of a new funding model for community pharmacy.

BACKGROUND: Recently, New Zealand has taken a system wide approach providing the biggest reform to New Zealand community pharmacy for 70 years with the aim of providing more clinically orientated patient centred services through a new funding model. The aim of this study was to understand the types of services offered in New Zealand community pharmacies since introduction of the new funding model, what the barriers are to providing these services. METHOD: A survey of all community pharmacies were undertaken between August, 2014 and February, 2015. Basic descriptive statistics were completed and group comparisons were made using the chi squared test with significance set at p < 0.05. RESULTS: 528 responses were received. Education and advice on prescription and non-prescription medicines were the two top listed services provided. There were no significant differences in service provision between rural and metro based pharmacies. Many pharmacies were considering introducing new patient centred services. Four of the top ten frequently provided services have no public funding attached. Costs and staff availability are the most common barriers to undertake services, more predominantly in patient centred services. CONCLUSION: This study was the first to provide an evaluation of service provision in response to a new funding model for New Zealand Community Pharmacies. A broad range of services are being undertaken in New Zealand community pharmacies including patient-centred services. A number of barriers to service provision were identified. This study provides a baseline for the current levels of service provision upon which future studies can compare to and evaluate any changes in service provision with differing funding models going forward.

An analysis of the global pharmacy workforce capacity trends from 2006 to 2012.

BACKGROUND: Human resources for health are at a critical low. The World Health Organization estimates that the current shortage of health workers, including pharmacists, is in excess of 7.2 million worldwide and that, by 2035, the shortage will reach 12.9 million. Pharmacists, in particular, are lacking in the workforce in many countries. The International Pharmaceutical Federation (FIP) and academic partners have conducted periodic global pharmacy workforce surveys in 2006, 2009 and 2012 which have monitored and reported on the status of the pharmacy workforce at the country and territory levels. This current analysis is a synthesis of workforce capacity data from these date points to provide an overview of the global trends and changes to pharmacy workforce capacity over this time period. METHODS: The methodology proceeded with accessing workforce capacity data collated in 2006, 2009 and 2012 held on file at the FIP Collaborating Centre. This data had previously been validated and made available to WHO Human Resources for Health. The data focused (due to limitations from 2006 databank) on pharmacist workforce capacity. Countries and territories were identified that had data available across at least two of the three time points (2006, 2009 and 2012). Missing time-point data for some countries (data gaps) were subject, where possible, to literature and online data searching to capture possible missing data. Country-level capacity data were plotted against time to identify trends coupled with comparative analysis of the trends. RESULTS: The countries and territories identified as having valid data for each of the time points 2006, 2009 and 2012 were present in all WHO regions, with Europe having the most countries with data available and South East Asia the fewest. All WHO regions have experienced an increase in the density of pharmacists (measured as number of pharmacists per 10 000 population) over the period 2006-2012. However, some countries show a reduction in the density of pharmacists. African countries show large relative increases in acceleration of capacity building but remain significantly behind in terms of absolute capacity per capita. South East Asian and Middle Eastern countries also show large proportional changes in pharmacist workforce. CONCLUSION: The global trend is an increase in workforce across all nations and regions, and this is a move in the right direction towards improved access to, and availability of, pharmaceutical expertise. However, there is still much to be done, with some regions and low-income countries still displaying a disproportionately low number of pharmacists on small overall capacity for delivering pharmacy services.

Hospital pharmacy workforce in Brazil.

BACKGROUND: This study aims to describe the distribution of the hospital pharmacy workforce in Brazil. METHODS: Data were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19. RESULTS: The number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals. CONCLUSION: This study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.

Evaluating pharmacist input into the pharmaceutical care of patients in dispensing medical practices in remote and rural areas of Scotland.

Background: The Highlands and the Western Isles are the two most remote and rural areas of Scotland, with many medical practices in areas where pharmacies would not be viable. Recent regulations state that that dispensing medical practices in these areas must receive pharmacist support for patients who would benefit. Objective: This study aimed to evaluate pilot services, which centred on the provision of patient centred pharmaceutical care. Methods: A realist type evaluation was conducted by an independent research team comprising collecting quantitative data around what occurred during the consultation followed by interviews with purposive samples of staff (n = 14) and patients (n = 18). Results: A total of 873 medicines related issues were identified in 473 patients reviewed, with the main issue being 'inappropriate dose, frequency, duration'. Just under half (39.7%) of issues were managed by the pharmacist without any medical input. Interviews indicated a high level of appreciation, although there was an increase in workload for some staff. While the need for telephone based pharmacist consultations for some patients was understood, there was a preference for face to face. All were supportive of continuing and extending the service. Conclusion: The clinical pharmacist service was both needed and valued highly by staff and patients. In Scotland, this aligns with the Government vision and action plan, 'Prescription for Excellence', that by 2023 all patient facing pharmacists will be independent prescribers with those in remote and rural areas entitled to 'equity of access to such expertise'.

Contribution of health workforce to health outcomes: empirical evidence from Vietnam.

BACKGROUND: In Vietnam, a lower-middle income country, while the overall skill- and knowledge-based quality of health workforce is improving, health workers are disproportionately distributed across different economic regions. A similar trend appears to be in relation to health outcomes between those regions. It is unclear, however, whether there is any relationship between the distribution of health workers and the achievement of health outcomes in the context of Vietnam. This study examines the statistical relationship between the availability of health workers and health outcomes across the different economic regions in Vietnam. METHODS: We constructed a panel data of six economic regions covering 8 years (2006-2013) and used principal components analysis regressions to estimate the impact of health workforce on health outcomes. The dependent variables representing the outcomes included life expectancy at birth, infant mortality, and under-five mortality rates. Besides the health workforce as our target explanatory variable, we also controlled for key demographic factors including regional income per capita, poverty rate, illiteracy rate, and population density. RESULTS: The numbers of doctors, nurses, midwives, and pharmacists have been rising in the country over the last decade. However, there are notable differences across the different categories. For example, while the numbers of nurses increased considerably between 2006 and 2013, the number of pharmacists slightly decreased between 2011 and 2013. We found statistically significant evidence of the impact of density of doctors, nurses, midwives, and pharmacists on improvement to life expectancy and reduction of infant and under-five mortality rates. CONCLUSIONS: Availability of different categories of health workforce can positively contribute to improvements in health outcomes and ultimately extend the life expectancy of populations. Therefore, increasing investment into more equitable distribution of four main categories of health workforce (doctors, nurses, midwives, and pharmacists) can be an important strategy for improving health outcomes in Vietnam and other similar contexts. Future interventions will also need to consider an integrated approach, building on the link between the health and the development.

An analysis of the global pharmacy workforce capacity.

BACKGROUND: The World Health Organization (WHO) estimates that there is a global healthcare workforce shortage of 7.2 million, which is predicted to grow to 12.9 million by 2035. Globally, people are living longer with multiple co-morbidities and require increased access and use of medicines. Pharmacists are a key component of the healthcare workforce, and in many countries, pharmacists are the most accessible healthcare profession. This paper identifies key issues and current trends affecting the global pharmacy workforce, in particular workforce distribution, country economic status, capacity, and workforce gender balance. METHODS: National professional pharmacy leadership bodies, together with other contacts for professional bodies, regulatory bodies, and universities, were approached to provide country-level data on pharmacy workforce. A descriptive and comparative analysis was conducted to assess each country's pharmacy workforce. RESULTS: A total of 89 countries and territories responded to the survey. To standardise the capacity measure, an analysis of the population density of pharmacists (per 10 000 population) was performed. The sample mean was 6 pharmacists per 10 000 population (n = 80). There is considerable variation between the surveyed countries/territories ranging from 0.02 (Somalia) to 25.07 (Malta) pharmacists per 10 000 population. African nations have significantly fewer pharmacists per capita. Pharmacist density correlates with gross national income (GNI) and health expenditure. The majority of pharmacists are employed in community settings, followed by hospital, industry-related, academia, and regulation. There is a greater proportion of females in the pharmacy workforce globally, with some WHO regions showing female representation of more than 65 % with an increasing trend trajectory. CONCLUSIONS: Pharmacy workforce capacity varies considerably between countries and regions and generally correlates with population- and country-level economic indicators. Those countries and territories with lower economic indicators tend to have fewer pharmacists and pharmacy technicians; this has implications for inequalities regarding access to medicines and medicine expertise.

Impact of Hurricane Sandy on community pharmacies in severely affected areas of New York City: A qualitative assessment.

Hurricane Sandy was one of the most severe natural disasters to hit the Mid-Atlantic States in recent history. Community pharmacies were among the businesses affected, with flooding and power outages significantly reducing services offered by many pharmacies. The objectives of our study were to assess the impact of Hurricane Sandy on community pharmacies, both independently owned and chain, in the severely affected areas of New York City (NYC), including Coney Island, Staten Island, and the Rockaways, using qualitative methods, and propose strategies to mitigate the impact of future storms and disasters. Of the total 52 solicited pharmacies, 35 (67 percent) responded and were included in our analysis. Only 10 (29 percent) of the pharmacies surveyed reported having a generator during Hurricane Sandy; 37 percent reported being equipped with a generator at the time of the survey approximately 1 year later. Our findings suggest that issues other than power outages contributed more toward a pharmacy remaining operational after the storm. Of those surveyed, 26 (74 percent) suffered from structural damage (most commonly in Coney Island). Most pharmacies (71 percent) were able to reopen within 1 month. Despite staffing challenges, most pharmacies (88 percent) had enough pharmacists/staff to resume normal operations. Overall, 91 percent were aware of law changes for emergency medication access, and 81 percent found the information easy to obtain. This survey helped inform our work toward improved community resiliency. Our findings have helped us recognize community pharmacists as important stakeholders and refocus our energy toward developing sustained partnerships with them in NYC as part of our ongoing preparedness strategy.

Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals.

OBJECTIVE: In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's "antimicrobial stewardship" group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST - antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities. METHODS: We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts' consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires. RESULTS: A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros. CONCLUSION: Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities.

Implementation and Operational Research: A Comparison of Two Task-Shifting Models of Pharmaceutical Care in Antiretroviral Treatment Programs in South Africa.

BACKGROUND: The severe shortage of pharmacists is an important limitation to providing antiretroviral treatment (ART) in resource-limited countries. Two task-shifting pharmaceutical care models have been developed to address this in South Africa, namely indirectly supervised pharmacist assistant (ISPA) and nurse-managed models. This study compared pharmaceutical care quality, patient clinical outcomes, and provider staff costs between these models. METHODS: An analysis of pharmaceutical quality audits, patient clinical data, and staff costing data collected at 7 ISPA and 8 nurse-managed facilities was undertaken. Pharmaceutical audits were conducted by pharmacists using a standardized tool. Routine clinical data were collected prospectively at patient visits, and staff human resources costs were analyzed. RESULTS: Overall pharmaceutical care quality scores were higher at ISPA sites than nurse-managed sites; 88.8% vs. 79.9%, respectively; risk ratio (ISPA vs. nurse) = 1.11 (95% confidence interval: 1.09 to 1.13; P < 0.0001). Mean provider pharmaceutical-related human resources costs per patient visit and per item dispensed were 29% and 49% lower, respectively, at ISPA facilities. At ISPA facilities, patient attrition was observed to be lower and viral suppression higher than at nurse-managed sites. CONCLUSION: The ISPA model had a higher quality of pharmaceutical care and was less costly to implement. Further expansion of this model or integrating it with nurse-managed ART may enhance the cost-efficient scale-up of ART programs in Sub-Saharan Africa.

Health worker migration from South Africa: causes, consequences and policy responses.

BACKGROUND: This paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries-Jamaica, India, the Philippines, and South Africa-have historically been "sources" of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa. METHODS: The study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically. RESULTS: There has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself. CONCLUSIONS: In the near past, South Africa's health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.

Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals.

INTRODUCTION: Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals. METHODS: A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes. RESULTS: Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities. CONCLUSIONS: This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants revealed that their sessional employment model increased access to pharmacist-mediated medication management support in rural hospitals. The contracting arrangements and scope of services may be evaluated and adapted in other rural hospitals.

A National Survey Assessing the Current Workforce of Transplant Pharmacists Across Accredited U.S. Solid Organ Transplant Programs.

Integration of pharmacists into multidisciplinary transplant patient care has advanced in recent years, with limited data available to evaluate the current status of the profession. This was a national survey developed as an AST Pharmacy COP initiative. Responses were solicited from pharmacists practicing at U.S. transplant programs based on UNOS listing; 176 participants from 113 centers (41%) responded, with 79% practicing ≤10 years. There is a median of 1.4 pharmacist full-time equivalents (FTEs) (range 0.1-7.1) for every 100 transplants. The predominant activities performed by pharmacists during the transplant phase include medication review (95%), lab review (92%), allergy review (88%), medication therapy management (92%), bedside rounds (87%), medication education (79%), documentation (71%), and coordinating discharge medications (58%). Similar activities were reported during the other phases, but participation was less common. The involvement of dedicated transplant pharmacists within multidisciplinary care has become standard at a large number of centers, although expansion is still needed to ensure core pharmaceutical care components are provided to all transplant recipients across all centers. These results inform on the typical responsibilities of pharmacists practicing within the field of transplantation and illustrate that the level of pharmacist involvement significantly varies across transplant centers and the phases of transplantation.

Examining pharmacy workforce issues in the United States and the United kingdom.

OBJECTIVE: To examine available data and actions surrounding current pharmacy workforce issues in the United States and United Kingdom. METHODS: Published pharmacy workforce data from the United States and United Kingdom were gathered from various sources, including PUBMED, Internet search engines, and pharmacy organization websites. Data was collated from additional sources including scientific literature, internal documents, news releases, and policy positions. RESULTS: The number of colleges and schools of pharmacy has expanded by approximately 50% in both the United States and United Kingdom over the previous decade. In the United States, continued demand for the pharmacy workforce has been forecasted, but this need is based on outdated supply figures and assumptions for economic recovery. In the United Kingdom, workforce modeling has predicted a significant future oversupply of pharmacists, and action within the profession has attempted to address the situation through educational planning and regulation. CONCLUSION: Workforce planning is an essential task for sustaining a healthy profession. Recent workforce planning mechanisms in the United Kingdom may provide guidance for renewed efforts within the profession in the United States.

Academic pharmacy strikes Hawai'i. Part 2.

In partnership with the Hawai'i Journal of Medicine & Public Health, the Daniel K. Inouye College of Pharmacy (DKICP) is pleased to provide Scripts on a regular basis. In the inaugural "Script," a brief history of the profession in Hawai'i was presented up to the founding of the DKICP, Hawai'i's only academic pharmacy program. In this second part of the inaugural article, we describe some key accomplishments to date. The mission of the College is to educate pharmacy practitioners and leaders to serve as a catalyst for innovations and discoveries in pharmaceutical sciences and practice for promoting health and well-being, and to provide community service, including quality patient care. Examples are given to support the stated goals of the mission. With 341 graduates to date, and a 96% pass rate on the national licensing board exams, the college has played a significant role in improving healthcare in Hawai'i and throughout the Pacific Region. Additionally, a PhD program with substantial research programs in both pharmacy practice and the pharmaceutical science has been launched. Considerable extramural funding has been garnered from organizations such as the National Institutes of Health and Centers for Medicare and Medicaid Services. The economic impact of the College is estimated to be over $50 million each year. With over 200 signed clinical affiliation agreements within the state as well as nationally and internationally, the DKICP has helped to ameliorate the shortage of pharmacists in the state, and has enhanced the profile and practice standard of the pharmacist's role on interprofessional health care teams.

Pharmacy technician-to-pharmacist ratios: a state-driven safety and quality decision.

OBJECTIVE: To discuss the policy of pharmacy technician-to-pharmacist ratios by comparing Florida as an example of legislative-led authority versus Tennessee as an example of board of pharmacy-led ruling. SUMMARY: Over the past 2 years, the Florida legislature has debated the issue of pharmacy staffing ratios, initially leaving the Florida Board of Pharmacy with little authority to advocate for and enact safe technician staffing ratios. Anticipating this situation, the Tennessee Board of Pharmacy created rules to meet pharmacy staffing needs while protecting the authority of the pharmacist-in-charge and promoting patient safety. Before enacting rules, members of the board toured the state and talked about proposed rule changes with pharmacists. The final rule sets the pharmacy technician-to-pharmacist ratio at 2:1 but permits a 4:1 ratio based on public safety considerations and availability of at least two Certified Pharmacy Technicians. CONCLUSION: Pharmacists and leaders within the profession should conduct further research on appropriate and safe ratios of pharmacy technicians to pharmacists, with a focus on safety and quality of care.