[Human Resource Development in Pharmaceutical Sciences in the New Era of Life Science].

Almost 20 years have passed since the six-year pharmaceutical education started as the standard educational course for pharmacists. The six-year pharmaceutical education was originally proposed to nurture the pharmacists who can play important roles in advanced medical care as part of the medical team. Importantly, recent advances in life science are providing additional scientific advantages for the graduates from the six-year pharmaceutical education system. In the new era of life science, clinical training in the six-year education will be beneficial not only for the clinical pharmacists but also for the pharmaceutical scientists. For example, in drug discovery research, numerous studies have been making efforts to identify therapeutic targets based on basic sciences so far. However, as a result of the innovation in life science, such as multi-omics analyses and molecular imaging, we can now perform patient-/disease-oriented research on molecular basis using clinical materials and information. Nowadays, with the help of data science, we can understand the pathophysiological status of individual patients and optimize pharmacotherapy from viewpoint of molecular biology in clinical setting. Moreover, in drug discovery research, we can explore and identify the drug targets by analyzing clinical samples and medical records. Thus, learning from the bedside in detail will develop future leaders, including pharmacists, scientists and pharmacist-scientists, who will pave the way for pharmaceutical sciences in the next generation.

Comercio ilegal de medicamentos, problemática enfocada en puntos de distribución y destrucción: unidades de eliminación de medicamentos e insumos / Illegal trade in medicines, problems focused on points of distribution and destruction: units for the disposal of medicines and supplies

Introducción: La falsificación y/o adulteración de medicamentos es un problema de salud pública el cual cada día se ve más reflejado en el país; una forma de evitarlo ya sea en mínima escala, es la correcta utilización de las unidades de eliminación de medicamentos e insumos, ayudando así a una eficaz desnaturalización y destrucción de estos.Objetivo General:Reconocer la importancia de la prevención del comercio ilegal de medicamentos mediante la utilización de las unidades de eliminación de medicamentos e insumos, en las etapas de comercialización y destrucción del producto, en los municipios de Santiago de Cali, La Unión y Jamundí en el Departamento del Valle del Cauca.Objetivos Específicos:•Medir el grado de conocimiento de las unidades de eliminación de medicamentos e insumos en cuanto a su funcionalidad e impacto en la población de Santiago Cali y en el municipio de La Unión Valle.•Analizar la incidencia de hallazgos de medicamentos en el material de reciclaje y su nivel de comercialización en Santiago de Cali y Jamundí.Método:Se realizó un estudio descriptivo- comparativo, de corte transversal, con enfoque cuantitativo que incluyó una muestra de 171 personas del municipio de Santiago de Cali y 89 personas en el municipio de La Unión Valle; una muestra de 21 recicladores del municipio de Santiago de Cali y 20 recicladores del municipio de Jamundí. El estudio fue realizado entre octubre y noviembre del 2022. Se utilizaron dos cuestionarios validados, diligenciados uno de forma virtual (grupo A) y otro de forma presencial (grupo B), el cual fue desarrollado de forma voluntaria.Resultados: Respecto al grupo de personas encuestadas en el grupo A, 45 que equivalen al 26.3% del universo de la población encuestada en Cali tienen conocimiento de las unidades de eliminación de medicamentos e insumos, 126 personas que equivalen al 73.7% no tienen conocimiento acerca del mismo.(AU)

Introduction: Counterfeiting and/or adulteration of medicines is a public health problem which is increasingly reflected in the country; One way to avoid it, whether on a small scale, is the correct use of the blue dot, thus helping to effectively denature and destroy them.General Objective: Recognize the importance of preventing the illegal trade of medicines using the blue point, in the stages of commercialization and destruction of the product, in the municipalities of Santiago de Cali, La Unión and Jamundí in the Department of Valle del Cauca.Specific Objectives: Measure the degree of knowledge of the blue dot in terms of its functionality and impact on the population of Santiago Cali and the municipality of La Uniòn Valle.Analyze the incidence of drug display in recycling material and its level of commercialization in Santiago de Cali and Jamundi.Method: A descriptive-comparative, cross-sectional study was conducted, with a quantitative approach that included a sample of 171 people from the municipality of Santiago de Cali and eighty-nine people from the municipality of La Union Valle, a sample of twenty-one recyclers from the municipality of Santiago de Cali and twenty recyclers from the municipality of Jamundí. The study was conducted between October and November 2022. Two validated questionnaires were used, one completed online (group A) and the other in person (group B), which was developed voluntarily.Results: Regarding the group of people surveyed in group A, 45, equivalent to 26.3% of the universe of the population surveyed in Cali, are aware of the blue dot, while 126 people, equivalent to 73.7%, are unaware of it. In Unión Valle, 14 people, equivalent to 15.7%, know about the blue dot, while 75 people, equivalent to 84.3%, are unaware of it.(AU)

Performance of ChatGPT on the pharmacist licensing examination in Taiwan.

BACKGROUND: ChatGPT is an artificial intelligence model trained for conversations. ChatGPT has been widely applied in general medical education and cardiology, but its application in pharmacy has been lacking. This study examined the accuracy of ChatGPT on the Taiwanese Pharmacist Licensing Examination and investigated its potential role in pharmacy education. METHODS: ChatGPT was used on the first Taiwanese Pharmacist Licensing Examination in 2023 in Mandarin and English. The questions were entered manually one by one. Graphical questions, chemical formulae, and tables were excluded. Textual questions were scored according to the number of correct answers. Chart question scores were determined by multiplying the number and the correct rate of text questions. This study was conducted from March 5 to March 10, 2023, by using ChatGPT 3.5. RESULTS: The correct rate of ChatGPT in Chinese and English questions was 54.4% and 56.9% in the first stage, and 53.8% and 67.6% in the second stage. On the Chinese test, only pharmacology and pharmacochemistry sections received passing scores. The English test scores were higher than the Chinese test scores across all subjects and were significantly higher in dispensing pharmacy and clinical pharmacy as well as therapeutics. CONCLUSION: ChatGPT 3.5 failed the Taiwanese Pharmacist Licensing Examination. Although it is not able to pass the examination, it can be improved quickly through deep learning. It reminds us that we should not only use multiple-choice questions to assess a pharmacist's ability, but also use more variety of evaluations in the future. Pharmacy education should be changed in line with the examination, and students must be able to use AI technology for self-learning. More importantly, we need to help students develop humanistic qualities and strengthen their ability to interact with patients, so that they can become warm-hearted healthcare professionals.

AAPS Perspective on the EURL Recommendation on the use of Non-Animal-Derived Antibodies.

In May 2020, the EU Reference Laboratory for alternatives to animal testing (EURL ECVAM) published a recommendation report entitled "Recommendation on nonanimal-derived antibodies". In this report, the EURL ECVAM specifically states: "Therefore, taking into consideration the ESAC Opinion on the scientific validity of replacements for animal-derived antibodies, EURL ECVAM recommends that animals should no longer be used for the development and production of antibodies for research, regulatory, diagnostic and therapeutic applications. The provisions of Directive 2010/63/EU should be respected, and EU countries should no longer authorise the development and production of antibodies through animal immunisation, where robust, legitimate scientific justification is lacking." (1). Here, we are providing the American Association of Pharmaceutical Scientists (AAPS) opinion on the EURL ECVAM recommendation report. In brief, there has been a clear and strong progress in reduction of animal use in the drug discovery and development process, including significant reduction of animal use in production of antibody reagents. Yet, it is proposed that more data need to be generated, shared and discussed within the scientific community before a decision to implement the change to non-animal derived antibodies is made.

Educational needs of oncology pharmacists: A survey by the International Society of Oncology Pharmacy Practitioners.

BACKGROUND: The International Society of Oncology Pharmacy Practitioners (ISOPP) is committed to providing educational resources to members for their continuous learning and professional development. This survey was conducted to explore the educational needs of International Society of Oncology Pharmacy Practitioners members for the purpose of developing resources to support future learning relevant to the diverse global pharmacy practitioner membership of our society. METHODS: A cross-sectional survey of International Society of Oncology Pharmacy Practitioners membership was conducted between 10 December 2018 and 15 January 2019. The survey contained 17 questions and consisted of four sections: (1) respondents' demographics, (2) common challenges/barriers faced by members in accessing oncology pharmacy education, (3) areas within oncology pharmacy where members need education and (4) preferred methods of education delivery. Descriptive statistics were utilized to summarize survey results. RESULTS: The survey was completed by 62 out of 363 International Society of Oncology Pharmacy Practitioners members (17% response rate). Respondents were from 19 different countries, representing all the habitable continents. Most respondents were practicing in North America (21%), Oceania (21%) and Asia (16%). The majority of respondents worked in inpatient cancer units (60%), ambulatory tertiary cancer centres (31%) and academia (26%). Reported barriers to accessing education relevant to oncology pharmacy practice included lack of financial support (44%), time spent travelling to attend educational activities (39%), limited learning opportunities in their country of practice (34%) and limited growth of the oncology pharmacy discipline in their country of practice (32%). The content areas of greatest demand included pharmacotherapy of various cancers followed by oncology pharmacy research, International Society of Oncology Pharmacy Practitioners oncology pharmacy practice standards, supportive care and medication safety. Among educational activities offered by International Society of Oncology Pharmacy Practitioners, respondents valued annual International Society of Oncology Pharmacy Practitioners symposia and Journal of Oncology Pharmacy Practice the most. Most respondents (87%) indicated webinars as an effective educational tool. CONCLUSION: Among an international oncology pharmacist cohort, we identified practice areas prioritized by pharmacists for continuing and professional development. Time and cost were common barriers to education, both in developing and developed countries. These survey findings may help to guide future education initiatives of International Society of Oncology Pharmacy Practitioners and other providers of pharmacist oncology education.

Joint Statement on Pediatric Education at Schools of Pharmacy.

Providing health care for children is a unique specialty, and pediatric patients represent approximately 25% of the population. Education of pharmacy students on patients across the lifespan is required by current Accreditation Council for Pharmacy Education standards and outcomes; thus, it is essential that pharmacy students gain a proficiency in caring for children. A collaborative panel of pediatric faculty members from schools and colleges of pharmacy was established to review the current literature regarding pediatric education in Doctor of Pharmacy curricula and establish updated recommendations for the provision of pediatric pharmacy education. This statement outlines five recommendations supporting inclusion of pediatric content and skills in Doctor of Pharmacy curricula.

Una nueva definición y reenfoque de la atención farmacéutica: el Documento de Barbate / A new definition and refocus of pharmaceutical care: the Barbate Document

OBJETIVO: Proponer una definición actualizada de atención farmacéutica, basada en el modelo capacidad-motivación-oportunidad (CMO), así como los elementos clave y las actividades óptimas para su desarrollo que garanticen los más altos niveles de calidad y excelencia en esta actividad profesional. MÉTODO: Se constituyó un grupo de trabajo compuesto por miembros de la Sociedad Española de Farmacia Hospitalaria y farmacéuticos de diferentes ámbitos asistenciales. Se realizó una revisión bibliográfica en PubMed sobre la evidencia científica disponible acerca de modelos de atención farmacéutica y actividades con mayor impacto y facilidad de implantación. Se elaboró una propuesta de definición y se extrajeron las iniciativas elegidas como elementos clave, distribuyéndolas en cada pilar del modelo propuesto. Tras unificar un primer listado de actividades y términos, el grupo de trabajo revisó y realizó correcciones o propuso nuevas actividades. Se consensuaron, adicionalmente, las definiciones de los tres elementos clave del modelo CMO: capacidad-motivación-oportunidad. El borrador final fue enviado a las diferentes sociedades científicas, farmacéuticas y médicas, así como a las asociaciones de pacientes con las que la Sociedad Española de Farmacia Hospitalaria tiene convenio de colaboración, a fin de incorporar nuevas sugerencias y aportaciones antes del consenso final. RESULTADOS: La definición de atención farmacéutica consensuada fue "La actividad profesional por la cual el farmacéutico se vincula con el paciente (y/o cuidador) y el resto de profesionales sanitarios, para aten-der a este en función de sus necesidades, planteando las estrategias para alinear y alcanzar los objetivos a corto y medio/largo plazo en relación a la farmacoterapia e incorporando las nuevas tecnologías y medios disponibles para llevar a cabo una interacción continuada con el mismo, con el fin de mejorar los resultados en salud". Se han identificado 27 elementos clave, distribuidos entre los tres pilares del modelo, para desarrollar esta actividad. CONCLUSIONES: Se ha consensuado una nueva definición de atención farmacéutica que permitirá reenfocar esta actividad profesional y avanzar desde el trabajo multidisciplinar hacia el enfoque longitudinal y multidimensional del paciente

OBJECTIVE: To propose an updated definition of Pharmaceutical Care based on the Capacity-Motivation-Opportunity (CMO) model and on the key elements and optimal activities for its development that guarantee the highest levels of quality and excellence in this professional activity. METHOD: The consensus was developed by a working group composed of members of the Spanish Society of Hospital Pharmacy and other pharmacists from different healthcare fields. A literature review of PubMed was conducted of the available scientific evidence on pharmaceutical healthcare models and activities with the greatest impact and ease of implementation. A working definition was developed and the initiatives chosen as key elements were collected and included in each pillar of the proposed model. After creating an initial list of activities and terms, the working group reviewed it and made corrections or proposed new activities. In addition, the definitions of the three key elements of the CMO model were agreed upon: Capacity-Motivation-Opportunity. In order to incorporate all appropriate suggestions and contributions before finalizing the consensus, the final draft was sent to the different scientific, pharmaceutical, and medical societies as well as patient associations with which the Spanish Society of Hospital Pharmacy has a collaboration agreement. RESULTS: The definition of consensual Pharmaceutical Care was "Any professional activity by which the pharmacist is linked to the patient (and/or caregiver) and other healthcare professionals, to attend to the patient ac-cording to their needs, setting out strategies to align and achieve the short- and medium-/long-term objectives of pharmacotherapy and incorporating new technologies and the means available to continuously interact with the patients in order to improve their health outcomes". In addition, agreement was reached on the definitions of the three key elements of the CMO model. Finally, 27 key elements for the development of pharmaceutical activity were identified and included in the three pillars of the model. CONCLUSIONS: A new definition of Pharmaceutical Care has been agreed upon that refocuses this professional activity, allowing us to advance within the multidisciplinary working approach toward a longitudinal and multidimensional approach to the patient

Cancer, immune suppression and Coronavirus Disease-19 (COVID-19): Need to manage drug safety (French Society for Oncology Pharmacy [SFPO] guidelines).

The Coronavirus disease (COVID-19) pandemic is disrupting our health environment. As expected, studies highlighted the great susceptibility of cancer patients to COVID-19 and more severe complications, leading oncologists to deeply rethink patient cancer care. This review is dedicated to the optimization of care pathways and therapeutics in cancer patients during the pandemic and aims to discuss successive issues. First we focused on the international guidelines proposing adjustments and alternative options to cancer care in order to limit hospital admission and cytopenic treatment in cancer patients, most of whom are immunocompromised. In addition cancer patients are prone to polypharmacy, enhancing the risk of drug-related problems as adverse events and drug-drug interactions. Due to increased risk in case of COVID-19, we reported a comprehensive review of all the drug-related problems between COVID-19 and antineoplastics. Moreover, in the absence of approved drug against COVID-19, infected patients may be included in clinical trials evaluating new drugs with a lack of knowledge, particularly in cancer patients. Focusing on the several experimental drugs currently being evaluated, we set up an original data board helping oncologists and pharmacists to identify promptly drug-related problems between antineoplastics and experimental drugs. Finally additional and concrete recommendations are provided, supporting oncologists and pharmacists in their efforts to manage cancer patients and to optimize their treatments in this new era related to COVID-19.

A multimethod evaluation of an interprofessional IPPE in an underserved clinic.

INTRODUCTION: To evaluate the design of an interprofessional introductory pharmacy practice experience (IP-IPPE) designed to integrate third-year pharmacy students in patient care workflow under the direct supervision of non-pharmacist practitioners in a federally qualified health center. METHODS: Data was gathered to evaluate the success of the IP-IPPE from the students', providers', and clinic's perspectives. Preceptors completed a mixed-methods survey to determine satisfaction and value of the IP-IPPE. Students completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) post-IP-IPPE to assess change in interprofessional outcomes. Student performance and competency demonstration was assessed using a modified interprofessional professional assessment scoring tool. Finally, a retrospective patient chart review was conducted to determine student value to the clinic. RESULTS: During a 12-week period at the studied clinic, 32 students were supervised by eight primary care providers (PCPs) and cared for 516 patients. Six providers (75%) endorsed students' ability to provide value-added interventions during clinical care. A chart review of 200 patient records indicated students provided medication education to 12% of patients engaged with, in addition to other contributions. Students' ICCAS self-assessments indicated significant improvement across all outcomes following the IP-IPPE. Qualitative provider responses indicated meaningful investment into the IP-IPPE and appreciation for pharmacy student's collaboration during patient care. CONCLUSION: All 32 students in this study were able to earn the trust of their assigned PCP preceptors. The IP-IPPE design created value for learners, patients, and providers.

Practice-enhancing publications about the medication-use process in 2018.

PURPOSE: This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2018 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following steps: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness toward daily practice change. SUMMARY: A PubMed search was conducted in February 2019 for articles published in calendar year 2018 using targeted Medical Subject Headings (MeSH) keywords, targeted non-MeSH keywords, and the table of contents of selected pharmacy journals, providing a total of 43,977 articles. A thorough review identified 62 potentially significant articles: 9 for prescribing/transcribing, 12 for dispensing, 13 for administration, and 28 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing recent impactful contributions to the MUP literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of significant published studies can assist in changing practice at the institutional level.

Unifying a profession and a health care system: Building the case for a "one pharmacy" global community.

The rational use of medicines to achieve better patient outcomes is a global concern. This need has pressured the practice of pharmacy to move away from focusing only on dispensing of the drug product towards the patient's appropriate utilization of the medicine. PharmAlliance, a unique partnership among three leading schools of pharmacy at the University of North Carolina at Chapel Hill (United States), Monash University (Australia), and University College London (United Kingdom), convened a Global Summit of Pharmacy Practice Innovation in November 2017 to bring together the leaders of the professional associations of the three countries to dialogue about how to lead the identified changes. A framework of "One Pharmacy Community" resulted from the discussions and was conceptualized from the overarching theme of the Summit. Recognizing and articulating these similarities into a One Pharmacy Community framework enables the development of a consistent global nomenclature of pharmacy services. The four pillars that resulted from the conversation are education, research, practice, and collaboration. Each of these are essential and dependent on the other in order to enable pharmacy practice to meet the global requirements of patient-focused health care design and delivery. This article describes the framework and each of the pillars.

Generosity, collegiality, and scientific accuracy when writing and reviewing original research.

In spite of concerns about the lack of recognition for its conduct, peer review remains the backbone of scientific evaluation and advancement of scientific knowledge. Given the challenges and evolution in the peer review system, collegiality among authors, reviewers, editors, and even consumers of content is more important than ever. While general guidance has been provided recently in the pharmacy literature, this commentary provides both philosophical underpinnings and specific mechanics for enhancing effectiveness of reviews and improving the quality of writing for authors concurrently, thus examining each major section in an original research contribution. Generosity, courtesy, diligence, thoroughness, and empathy are required of us all to advance the scientific paradigm of our discipline and profession.

Relationship between regulatory barriers to entry and pharmacy technician wages.

BACKGROUND: Pharmacy technicians are vital to the operation of pharmacies, and national pharmacy associations have advocated for mandatory education and training requirements. While these requirements may improve patient safety, there is a risk that laws and regulations which impose substantial education and training requirements on technicians could create barriers to entry which restrict the workforce and increase wages. OBJECTIVE: This study has two objectives: 1) Describe changes in barriers to entry and wages over time; and 2) Evaluate the correlation between changing barriers to entry and pharmacy technician wages. METHODS: Data come from Bureau of Labor Statistics Occupational Employment Statistics from 1997 to 2017 and National Association of Boards of Pharmacy Surveys of Pharmacy Law from 1997 to 2014. A barrier to entry was defined as adoption of registration, licensure, or certification. Wage data was adjusted to 2017 dollars using the Consumer Price Index. Ordinary least squares regression evaluated the correlation between the proportion of states which had at least one barrier to entry and wages. An interrupted time series model estimated the impact of adopting a barrier to entry on the trend in technician wages over time. RESULTS: Technician wages increased between 1997 and 2007 but remained flat between 2008 and 2017. A strong correlation was observed between the proportion of states which had at least one barrier to entry and technician wages (R2 = 0.93, p < 0.0001). However, the interrupted time series models did not identify any relationship between adoption of a barrier to entry and the trend in technician wages (p = 0.363). CONCLUSIONS: This research suggests adoption of legal/regulatory barriers to entry did not have a significant influence on the trend in technician wages over time. More research is needed to evaluate the impact of barriers to entry on non-wage practice variables, such as privileges and satisfaction.

Seguridad en las prácticas de laboratorio: caso de los practicantes de farmacia / Safety in laboratory practices: case of pharmacy practitioners

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Confirmación de los compromisos de una Farmacia Amigable / Confirmation of the commitments of a Friendly Pharmacy

INTRODUCCIÓN: La farmacia se encuentra en pleno proceso de trasformación. Dada su accesibilidad y cercanía con la atención primaria, una de las vías de desarrollo de la farmacia comunitaria debería ser la profundización en aspectos sociales. OBJETIVOS: Confirmar si las personas mayores que acuden a las farmacias siguen pensando que los compromisos anteriormente definidos son los que deben definir a la Farmacia Amigable (FA). MATERIAL Y MÉTODOS: Se realizó un grupo focal con personas mayores en San Sebastián. Se contactó con los individuos responsables de tres organizaciones relacionadas con las personas mayores. Se grabó y analizó siguiendo el método de análisis de contenido dirigido. RESULTADOS: Se confirmaron los 15 compromisos ya publicados que definen una FA. CONCLUSIONES: Confirmados los compromisos que definen una FA desde el Colegio Oficial de Farmacéuticos de Gipuzkoa se pretende que la red de farmacias sea más cercana, accesible y que esté cada vez más inmersa en el ámbito social

INTRODUCTION: The community pharmacy is in a process of transformation. Due to its accessibility and proximity with primary care, one of the development paths should be the deepening in social aspects. OBJECTIVE: Confirm if the elderly people who go to the pharmacies still think that the commitments that define the Friendly Pharmacy are the ones previously identified. MATERIAL AND METHODS: A focus group was carried out with elderly people. An invitation to participate was elaborated and the responsible people for three organizations related to elderly people were contacted. It was recorded and analyzed as a directed content analysis method. RESULTS: It has been possible to verify that, in a general way, the participants confirmed the data obtained in the previous work. CONCLUSIONS: The commitments aimed at developing a closer, more accessible pharmacy network and increasingly involved in the social field, are confirmed

Self-perceived knowledge and confidence regarding infectious diseases of advanced pharmacy practice experience students.

INTRODUCTION: Knowledge in infectious diseases (ID) pharmacotherapy and antimicrobial stewardship is becoming increasingly important for pharmacists. Pharmacy schools utilize multiple methods to teach ID pharmacotherapy including advanced pharmacy practice experiences (APPEs). METHODS: An internet-based survey was sent to students currently on APPEs at four colleges/schools of pharmacy. The primary study objective was a comparison of self-perceived ID knowledge and confidence prior to starting and during APPEs. The secondary objectives were to determine the level of self-perceived knowledge and confidence of students who have completed an ID APPE to those who have not, as well as the level of interest in postgraduate year 1 (PGY-1) and ID-specific postgraduate year 2 (PGY-2) residencies. RESULTS: All statements revealed a statistically significant increase in self-perceived ID knowledge and confidence for students during APPEs compared to before starting rotations (p-values < 0.001). Students who completed an ID APPE had an overall increase in both self-perceived knowledge and confidence for all aspects. Completion of an ID APPE enhanced self-perceived knowledge in basic microbiology fundamentals, antimicrobial stewardship principles, and overall ID knowledge. Completion of an ID APPE created a higher level of confidence regarding selecting appropriate antimicrobial therapy, interpreting cultures and susceptibilities to de-escalate, and communicating with other healthcare professionals. CONCLUSIONS: Students who completed an ID APPE had a higher level of self-perceived knowledge and confidence than those who had not. Recent increases in demand for antimicrobial stewardship positions warrants maximization of ID and non-ID APPEs to enhance students' knowledge and confidence in infectious diseases.

Understanding Payer Perspectives on Value in the Use of Pharmaceuticals in the United States.

BACKGROUND: In recent years, value assessment frameworks have been introduced to inform discussions about how to define and assess value in the U.S. health care system. However, there is uncertainty as to how value assessment frameworks and other approaches to achieve value such as outcomes-based contracting are perceived and used in coverage decisions. OBJECTIVE: To understand how U.S. payers determine value in the use of pharmaceuticals and how it differs from payers outside the United States. METHODS: Qualitative in-depth phone interviews with 13 executive-level public and private U.S. managed care representatives and 6 health technology assessment advisors outside the United States were conducted from September to November 2017. RESULTS: Despite various mechanisms used by U.S. payers to assess value, no consistent definitions of value were provided, and U.S. payers felt limited in what they can do to achieve value in pharmaceutical decision making. Value assessment frameworks are not formally considered in formulary and reimbursement decisions but are used as a reference as they become available by most or all U.S. health plans. U.S. payers expressed concerns, including limited control over pharmaceutical pricing and budget caps, and limited ability to use incremental cost per quality-adjusted life-year thresholds. Outcomes-based contracting could have some utility in specific cases where the treatment has a particularly high cost and a clear outcomes measure, but payers indicated that outcomes-based contracts can be difficult to operationalize, and determination of savings was uncertain. Payers outside the United States-who are enabled by government health care bodies, policy tools, and analytical frameworks that have no counterpart in the United States-have a wider array of instruments at their disposal. U.S. payers were largely open to learning from other health care systems outside the United States, particularly the German health care system, where patient-relevant benefit compared with a predetermined treatment comparator is the primary determinant for price negotiations. CONCLUSIONS: Although there is interest in including value assessment frameworks during the decision-making process in the United States, there are significant challenges to operationalizing them. The current environment in the United States restricts payers' ability to make favorable contracts with manufacturers, and changes to the U.S. health system design are needed to facilitate this effort. Adoption of a value assessment framework in Medicare or Medicaid would accelerate adoption of these tools by private payers in the United States. DISCLOSURES: This study was conducted by RTI Health Solutions under the direction of The Pew Charitable Trusts and was funded by The Pew Charitable Trusts. Vekaria is employed by RTI Health Solutions. Reynolds and Coukell are employed by The Pew Charitable Trusts. Brogan and Hogue have nothing to disclose.