Prescription digital therapeutics: A new frontier for pharmacists and the future of treatment.

Within digital health, digital therapeutics (DTx) are increasingly used to provide clinical treatment. DTx are evidence-based, U.S. Food and Drug Administration-authorized software to treat or manage medical conditions and are available either via prescription or as nonprescription products. DTx that require clinician initiation and oversight are called prescription DTx (PDTs). DTx and PDTs have unique mechanisms of action and are expanding treatment options beyond traditional pharmacotherapy. They may be implemented on their own or used in combination with a drug and in some cases may be the only treatment option for a particular disease state. This article explains how DTx and PDTs function and how these technologies can be incorporated by pharmacists as they attend to their patients' care.

From ideation to practice: How pharmacists and students can leverage hackathons and innovation labs to accelerate innovation in pharmacy.

OBJECTIVES: To describe novel methods regarding innovation for pharmacists and student pharmacists to leverage local and national events, such as hackathons and innovation labs, that provide guidance and resources for developing novel products and solutions in health care. DATA SOURCES: Not applicable. SUMMARY: The profession of pharmacy exists in a diverse and complex system where collaboration is essential for innovation and can leverage existing resources to accelerate this. Hackathons occur over one or more days and offer a venue and resources to support innovation as interprofessional teams develop and pitch new product ideas for potential investment. Innovation labs serve as more permanent locations that offer resources and expertise to help realize ideas and guide development into potentially viable solutions and products for health care. CONCLUSION: Although currently hosted hackathons and design spaces may prove to be beneficial to pharmacists looking to innovate, they are frequently located in urban areas or large academic institutions that are not readily accessible to the larger pharmacy community. Fostering opportunities, whether as local hackathons or innovation labs, can potentially help to accelerate the innovation cycle for the pharmacy profession. These resources can be developed in local communities or through national pharmacy societies and organizations to increase access.

Crowdfunding pharmacy- and medication-related products: How successful is it?

OBJECTIVE: To determine whether crowdfunding of pharmacy-related products through popular online platforms is a viable means to attain funding and what factors influence success. METHODS: Kickstarter and Indiegogo were searched for projects related to pharmacy using select key words. Projects were included for analysis if they were a device or system relevant to pharmacy care and excluded if found to be nonrelevant to medication management purposes or were of an artistic nature. Projects were assessed for their success in reaching their primary funding goals and also whether they were still in business following completion of their crowdfunding phase. RESULTS: Subsequent to the application of the inclusion and exclusion criteria to the dataset, 40 projects were identified, of which 13 reached their desired crowdfunding funding amounts. The most commonly created crowdfunded projects were those involving medication adherence or storage tools. Anecdotal evidence points to media attention leading to continued success beyond the initial crowdfunding phase of the business. The presence of a medical professional on the project team or the inclusion of a product demonstration did not lead to a different rate of success. CONCLUSION: The crowdfunding of pharmacy care-related products appear to have a low success rate, although Indiegogo might offer a higher success rate compared with Kickstarter in this niche product area. The products' ability to garner media attention seems to be a primary driver in the business surviving past the crowdfunding stage and becoming a lasting success.

Cost savings impact of a pharmacist-initiated teleservice program for Medicare Part D reviews.

OBJECTIVES: To (a) determine potential cost savings of a pharmacy outreach teleservice program conducting Medicare Part D plan reviews for a large population of beneficiaries allowing for comparison of multiple preferences; and (b) explore client demographic comparisons, plan features, and stratification by cost and number of medications. METHODS: Retrospective cohort evaluation of a Medicare D review service during open enrollment period (October 15 to December 7, 2012). Reviews were conducted at a university-based pharmacy outreach program in Massachusetts and completed by pharmacists (17%), case managers (52%), and students (31%). Recommendations were created by entering medication regimens into the Medicare.gov plan finder, and factors including deductible, premium, and copayment or coinsurance, formulary restrictions, secondary assistance, and annual cost were considered. A comparison of the overall cost of the client's 2012 plan in 2013 with that of a lower-cost plan in the 2013 benefit year determined potential cost savings. RESULTS: Demographic data were available for 1062 individuals, with the majority being women (66%), an overall mean age of 73 years, and most living in a single household. Clients (75%) were taking 5 or more medications. Lower-cost plans were recommended for 61% of clients with a median cost savings valued at $538 per member, per year. Cost was the leading consideration for plan change (87.4%), followed by deductible (32.7%) and premium (30.1%). Cost savings were analyzed by evaluating current plan versus alternate plan by sex, age, client type (repeat vs. referred vs. new), and according to number of medications. Lower-cost plans were identified for 75% of new members. Individuals taking 0-14 medications had a cost savings of approximately $833 per client per year. CONCLUSION: Teleservice pharmacy outreach programs create value by identifying therapeutically comparable alternative plans and reducing plan spending while efficiently consulting for a large number of Medicare Part D beneficiaries statewide.

Leveraging mobile smart devices to improve interprofessional communications in inpatient practice setting: A literature review.

As mobile smart device use has increased in society, the healthcare community has begun using these devices for communication among professionals in practice settings. The purpose of this review is to describe primary literature which reports on the experiences with interprofessional healthcare communication via mobile smart devices. Based on these findings, this review also addresses how these devices may be utilized to facilitate interprofessional education (IPE) in health professions education programs. The literature search revealed limited assessments of mobile smart device use in clinical practice settings. In available reports, communication with mobile smart devices was perceived as more effective and faster among interdisciplinary members. Notable drawbacks included discrepancies in the urgency labeling of messages, increased interruptions associated with constant accessibility to team members, and professionalism breakdowns. Recently developed interprofessional competencies include an emphasis on ensuring that health profession students can effectively communicate on interprofessional teams. With the increasing reliance on mobile smart devices in the absence of robust benefit and risk assessments on their use in clinical practice settings, use of these devices may be leveraged to facilitate IPE activities in health education professions programs while simultaneously educating students on their proper use in patient care settings.

Expanding clinical and information services to the ambulatory older adult through community outreach programs.

OBJECTIVE: To share successful techniques pharmacists can use to educate community-based older adults about health and medications. SETTING: Events coordinated through MCPHS University Pharmacy Outreach Program and offered at Massachusetts senior centers. PRACTICE DESCRIPTION: The MCPHS University Pharmacy Outreach Program, staffed with pharmacists, caseworkers, and pharmacy students, under the supervision of licensed pharmacists, provides free medication-related information to Massachusetts residents. Clients also receive assistance with cost-minimizing programs and insurance benefits. Seventy percent of contacts are older adults. Services are provided through a toll-free number and outreach programs. PRACTICE INNOVATION: Focus on expanding educational health services and includes selecting Medicare D plans, working with support groups, providing medication management for diverse cultures, educating older adults on how to search for health information on the Internet, and discussing medication safety and adherence. MAIN OUTCOME MEASUREMENTS: Participant and pharmacy student knowledge assessed utilizing survey tools. Additional measurements include savings for Medicare beneficiaries and improvements in medication management. RESULTS: Observed results of the Pharmacy Outreach Program include decreased out-of-pocket costs for Medicare beneficiaries, improved medication adherence resulting in reduction of glycated hemoglobin and blood pressure, identifying and recommending medication treatment changes to reduce patient fall risk, and increased confidence in locating Web-based health information. Pharmacy students demonstrated increased knowledge of and ability to communicate Medicare benefits. CONCLUSION: Outreach programs can improve older adults' understanding about their health and medications. Pharmacists can increase visibility in the community by engaging in effective outreach programs.

Medical applications for pharmacists using mobile devices.

BACKGROUND: Mobile devices (eg, smartphones, tablet computers) have become ubiquitous and subsequently there has been a growth in mobile applications (apps). Concurrently, mobile devices have been integrated into health care practice due to the availability and quality of medical apps. These mobile medical apps offer increased access to clinical references and point-of-care tools. However, there has been little identification of mobile medical apps suitable for the practice of pharmacy. OBJECTIVE: To address the shortage of recommendations of mobile medical apps for pharmacists in daily practice. DATA SOURCES: Mobile medical apps were identified via the iTunes and Google Play Stores via the "Medical" app categories and key word searches (eg, drug information, medical calculators). In addition, reviews provided by professional mobile medical app review websites were used to identify apps. STUDY SELECTION AND DATA EXTRACTION: Mobile medical apps were included if they had been updated in the previous 3 months, were available in the US, used evidence-based information or literature support, had dedicated app support, and demonstrated stability. Exclusion criteria included apps that were not available in English, had advertisement bias, used nonreferenced sources, were available only via an institution-only subscription, and were web-based portals. DATA SYNTHESIS: Twenty-seven mobile apps were identified and reviewed that involved general pharmacy practice, including apps that involved drug references, clinical references, medical calculators, laboratory references, news and continuing medical education, and productivity. CONCLUSIONS: Mobile medical apps have a variety of features that are beneficial to pharmacy practice. Individual clinicians should consider several characteristics of these apps to determine which are suitable to incorporate into their daily practice.

The Role of Artificial Intelligence in the Future of Pharmacy Education.

Recent developments making an artificial intelligence (AI) large language model available for public use have generated significant interest and angst among educators. Viewed as both a time saver and a threat to academic integrity, several questions have arisen about AI's role in education. Numerous opportunities exist to use AI for teaching and learning, but new questions have also arisen regarding AI's impact on the future of healthcare. The pharmacy Academy should be at the center of these discussions to address the technical, philosophical, and ethical issues that AI presents for the future of pharmacy and pharmacy education.

Effect of sodium nitroprusside on the occurrence of atrial fibrillation after cardiothoracic surgery.

BACKGROUND: Postoperative atrial fibrillation (POAF) is a frequent complication following cardiothoracic surgery and is associated with an increase in morbidity, mortality, and cost. One small prospective study of patients undergoing isolated coronary artery bypass graft surgery has demonstrated a decrease in the risk of POAF with the use of sodium nitroprusside. OBJECTIVE: To determine whether there is an association between intraoperative sodium nitroprusside use and the incidence of POAF. METHODS: A retrospective cohort of 1025 patients aged 18 years and older who underwent any cardiac surgery between April 2007 and July 2010 was evaluated at Regional Hospital of Scranton. Patients with a history of atrial fibrillation, those who had undergone cardiothoracic surgery, or those undergoing surgical treatment for atrial fibrillation were excluded. The primary outcome was the odds of developing POAF given the utilization of sodium nitroprusside during cardiothoracic surgery. POAF was defined according to the Society of Thoracic Surgeons Adult Cardiac Surgery Database version 2.61 as a new onset of atrial fibrillation/flutter requiring treatment that was not present preoperatively. Data on use of intraoperative sodium nitroprusside were obtained from the pharmacy department's billing database. RESULTS: The final analysis included 699 patients; 473 received sodium nitroprusside. The incidence of POAF was 25.4% in the sodium nitroprusside group and 27.9% in the control group. Univariate analysis demonstrated no association of sodium nitroprusside with POAF (OR 0.880; 95% CI 0.615 to 1.257). Multivariate analysis also showed no significant difference in the odds of POAF with sodium nitroprusside (OR 0.827; 95% CI 0.565 to 1.210). Repeating the analysis in 276 propensity score-matched patients also failed to demonstrate any association (OR 0.774; 95% CI 0.454 to 1.319). CONCLUSIONS: There was no significant association between the use of sodium nitroprusside during cardiothoracic surgery and POAF.

The good, the bad, and the poorly designed: The mobile app stores are not a user-friendly experience for health and medical purposes.

The utilization of mobile health applications to help manage health conditions have grown in utilization within the past decade. However, the application stores (i.e. Google and Apple) are not designed in a user-friendly manner that allows consumers to identify high-quality health and medical-related mobile applications. Researchers have been interested in identifying applications that may be recommended for patient care but have found the ability to quantify and assess these applications to be difficult due to the current layout and organization of applications. We explain here in this brief communication our own research experience in the identification of mobile health applications on the application stores, along with trends noted in other mobile health research, and make suggestions on how the application store experience could be improved for both patients and health professionals. These include collaboration between developers, medical professionals and organizations, and technology companies to facilitate a better means of categorizing health applications for patient use, alongside other current endeavors being pursued such as application review organizations and the creation of digital health formulary databases.

Optimizing Social Support in Oncology with Digital Platforms.

Increased cancer prevalence and survival rates coupled with earlier patient discharges from hospitals have created a greater need for social support. Cancer care is both short term and long term, requiring acute treatments, treatments for remission, and long-term screenings and treatment regimens. Health care systems are already overwhelmed and often struggle to provide social support systems for everyone. Caregivers are limited in number, and even when they are available, they often lack necessary information, skills, or resources to meet the needs of patients with cancer. The act of caregiving presents various challenges, and caregivers themselves often need social support as well. Despite these needs, most social support programs are targeted toward patients alone. Given the prevalence of cancer and known needs of these patients and their caregivers, the ability to identify those who need social support is crucial. Further, the scalability and overall availability of social support programs is vital for successful patient care. This paper establishes the benefits of social support for both patients and caregivers coping with cancer treatments, explores innovative ways of identifying patients who may need social support using digital tools, and reviews potential advantages of digital social support programs.

Reevaluating medication adherence in the era of digital health.

INTRODUCTION: Medication adherence is a worldwide issue impacting more than half the population. The cost associated with nonadherence is tremendous and has spurred the growth of novel technologies to address this growing problem. AREAS COVERED: This perspective covers the different digital health medication adherence tools that have come to market in the past decade and their clinical impact. These digital interventions and their applicability to medication adherence across different stakeholders are then evaluated. EXPERT OPINION: Digital health will play a significant role in creating new pathways to care in the 2020s. However, the current design of medication adherence tools has not demonstrated a clinical impact that will be relevant for the digital health space without a change in redesign factoring in relevant stakeholders' incentives to address adherence issues. A focus on only adherence has not yielded the economic or clinical benefit as expected, which is likely due to a lack of focus on broader drug-related problems (DRPs) that are causative factors beyond adherence alone. As such, adherence tools will see disparate uptake, likely due to condition-specific interventions rather than adherence issues as a whole, and future endeavors will need to address the larger DRP considerations to actualize clinical outcomes.

Digital Health Integration Assessment and Maturity of the United States Biopharmaceutical Industry: Forces Driving the Next Generation of Connected Autoinjectable Devices.

Autoinjectable devices continue to provide real-life benefits for patients with chronic conditions since their widespread adoption 30 years ago with the rise of macromolecules. Nonetheless, issues surrounding adherence, patient administration techniques, disease self-management, and data outcomes at scale persist despite product design innovation. The interface of drug device combination products and digital health technologies formulates a value proposition for next-generation autoinjectable devices to power the delivery of precision care at home and achieve the full potential of biologics. Success will largely be dependent on biopharma's digital health maturity to implement this framework. This viewpoint measures the digital health maturity of the top 15 biopharmaceutical companies in the US biologics autoinjector market and establishes the framework for next-generation autoinjectable devices powering home-based precision care and the need for formal digital health training.

Integrating Digital Health into the Curriculum-Considerations on the Current Landscape and Future Developments.

The intercession of widespread Internet access and use of mobile devices and wearables has increased the attention to the field of digital health as a novel means of providing patient care. Although substantial advancements have been made toward the development of novel technologies and identification of therapeutic areas of impact, the issue remains of how to educate future health professionals to work in an era of digital tools. This perspective piece seeks to highlight areas of concern related to subset areas of the digital health environment and provide potential educational pathways to prepare students.

Reducing Hospitalizations and Emergency Department Visits in Patients With Venous Thromboembolism Using a Multicomponent Care Transition Intervention.

Preventing utilization of hospital and emergency department after diagnosis of venous thromboembolism is a complex problem. The objective of this study is to assess the impact of a care transition intervention on hospitalizations and emergency department visits after venous thromboembolism. We randomized adults diagnosed with a new episode of venous thromboembolism to usual care or a multicomponent intervention that included a home pharmacist visit in the week after randomization (typically occurring at time of discharge), illustrated medication instructions distributed during home visit, and a follow-up phone call with an anticoagulation expert scheduled for 8 to 30 days from time of randomization. Through physician chart review of the 90 days following randomization, we measured the incidence rate of hospital and emergency department visits for each group and their ratio. We also determined which visits were related to recurrent venous thromboembolism, bleeding, or anticoagulation and which where preventable. We enrolled 77 intervention and 85 control patients. The incidence rate was 4.50 versus 6.01 visits per 1000 patient days in the intervention versus control group (incidence rate ratio = 0.71; 95% confidence interval = 0.40-1.27). Most visits in the control group were not related to venous thromboembolism or bleeding (21%) and of those that were, most were not preventable (25%). The adjusted incidence rate ratio for the intervention was 1.05 (95% confidence interval = 0.57-1.91). Our patients had a significant number of hospital and emergency department visits after diagnosis. Most visits were not related to recurrent venous thromboembolism or bleeding and of those that were, most were not preventable. Our multicomponent intervention did not decrease hospitalizations and emergency department visits.