A data-driven quality-score system for rating drug products and its implications for the health care industry.

The quality of drug products in the United States has been a matter of growing concern. Buyers and payers of pharmaceuticals have limited insight into measures of drug-product quality. Therefore, a quality-score system driven by data collection is proposed to differentiate between the qualities of drug products produced by different manufacturers. The quality scores derived using this proposed system would be based upon public regulatory data and independently-derived chemical data. A workflow for integrating the system into procurement decisions within health care organizations is also suggested. The implementation of such a quality-score system would benefit health care organizations by including the consideration of the quality of products while also considering price as a part of the drug procurement process. Such a system would also benefit the U.S. health care industry by bringing accountability and transparency into the drug supply chain and incentivizing manufacturers to place an increased emphasis on the quality and safety of their drug products.

Prevagen®: Analysis of Clinical Evidence and Its Designation as a "#1 Pharmacist Recommended Brand".

Prevagen® is a dietary supplement that is marketed to help with mild memory loss associated with older people. The manufacturer of the product notes that clinical evidence supports this use. Furthermore, the manufacturer notes that Prevagen® is a "#1 Pharmacist Recommended Brand." The authors' search of the literature identified one clinical study that evaluated the efficacy and safety of Prevagen®; however, this study possesses significant limitations and therefore one must question the merits of such clinical evidence. Prevagen®'s designation as a "#1 Pharmacist Recommended Brand" is based on a survey facilitated by Pharmacy Times® that is designed to identify the brand name over-the-counter products that pharmacists recommend most frequently. Because of the limited clinical data supporting Prevagen®'s efficacy, it is likely that the survey results reflect pharmacists' familiarity with this product, which may be influenced by extensive advertising techniques. As practitioners of evidence-based medicine, pharmacists should not recommend a product with limited evidence to support its use. Furthermore, pharmacists should proactively educate their patients, especially those who are most vulnerable, about the rational use of all pharmacologically active substances, including dietary supplements.

Medical Communications in an Agency Setting: A Career Option for Pharmacists.

Medical communications (MedComms) agencies serve the varied needs of the pharmaceutical industry and other healthcare-related organizations. These agencies present a unique practice opportunity for pharmacists who possess the requisite knowledge and skillset to flourish and grow professionally in this environment. Published information about this sector of the industry is limited. To this end, this article provides an overview of the MedComms agency setting and describes the services provided by such agencies. These include the development of branded and/or unbranded communications materials in the form of publications, oral and video presentations, slide decks, and other materials. MedComms professionals also facilitate and support professional meetings and presentations, such as congresses, symposia, and advisory boards. Other services that MedComms agencies provide include engaging key opinion leaders, providing clinical trial services, and brand identification or positioning. The article describes the opportunities for pharmacists in this field, key characteristics and skills needed to succeed in this industry, and the pathway for pharmacists to enter this field.

Survey of drug information centers in the United States-2018.

PURPOSE: To provide a current directory of drug information centers (DICs) in the United States and present information about their characteristics, activities and services, and networking activities. METHODS: In February 2018, an electronic 23-question survey was delivered to 118 contacts on a distribution list compiled from previous directories of DICs, responses to listserv messages, and an Internet search. DICs, defined as formal centers dedicated to providing drug information services, including but not limited to responding to drug information requests, were asked questions about their characteristics, activities and services, drug information requests, and networking activities. RESULTS: The response rate was 79% (93 of 118 DICs). Of the 93 respondents, 82 (88%) met the definition of a DIC and were included in the directory. Of the 82 included DICs, 37 (45%) belonged to a university or college, while 36 (44%) belonged to a medical center or hospital. Seventy percent of the DICs (n = 57) had been in existence for more than 20 years. Of the 81 respondents reporting activities performed at the DICs, precepting pharmacy students (n = 79, 98%) and training pharmacy residents and/or fellows (n = 68, 84%) were most commonly reported. Nearly 90% reported that answering drug information questions was central to the DIC operations. Most DICs (n = 52, 65%) indicated receiving an average of 50 requests or less on a monthly basis. DICs reported a variety of electronic means of communicating with the DIC community, although 16 (21%) of the 77 respondents reported no need to do so. CONCLUSION: The survey identified 82 DICs that collectively provide a variety of services to their clienteles. The DIC directory published herein should facilitate networking among DICs.

Clinical and other specialty services offered by pharmacists in the community: the international arena and Israel.

The community pharmacy setting is a venue that is readily accessible to the public. In addition, it is staffed by a pharmacist, who is a healthcare provider, trained and capable of delivering comprehensive pharmaceutical care. As such, community pharmacists have a colossal opportunity to serve as key contributors to patients' health by ensuring appropriate use of medications, preventing medication misadventures, identifying drug-therapy needs, as well as by being involved in disease management, screening, and prevention programs. This unique position gives the pharmacist the privilege and duty to serve patients in roles other than solely that of the stereotypical drug dispenser.Worldwide, as well as in Israel, pharmacists already offer a variety of pharmaceutical services and tend to patients' and the healthcare system's needs. This article provides examples of professional, clinical or other specialty services offered by community pharmacists around the world and in Israel and describes these interventions as well as the evidence for their efficacy. Examples of such activities which were recently introduced to the Israeli pharmacy landscape due to legislative changes which expanded the pharmacist's scope of practice include emergency supply of medications, pharmacists prescribing, and influenza vaccination. Despite the progress already made, further expansion of these opportunities is warranted but challenging. Independent prescribing, as practiced in the United Kingdom or collaborative drug therapy management programs, as practiced in the United States, expansion of vaccination programs, or wide-spread recognition and reimbursement for medication therapy management (MTM) programs are unrealized opportunities. Obstacles such as time constraints, lack of financial incentives, inadequate facilities and technology, and lack of professional buy-in, and suggested means for overcoming these challenges are also discussed.

Prevalence and characteristics of pharmacies owned and operated by schools of pharmacy in the United States.

INTRODUCTION: To identify schools/colleges of pharmacy that own and operate a pharmacy and to gather key details about such pharmacies. METHODS: Schools of pharmacy (n = 134) in the United States were contacted to determine whether they own and operate a pharmacy. Schools identified as having a pharmacy were subsequently sent an online questionnaire to solicit information about school and pharmacy characteristics. RESULTS: Eighteen (13.4%) schools reported owning and operating at least one pharmacy; of these, 14 (77.8%) responded to the questionnaire. The provision of education was a goal for all pharmacies. Pharmacy services were provided to students, faculty/staff, and community members (85.7%, 78.6%, and 50%, respectively). Student pharmacists were regularly involved in the operations of 13 (92.9%) pharmacies, largely as part of their introductory and advanced pharmacy practice experiences and/or as paid employees. CONCLUSION: Few schools of pharmacy in the United States own and operate a pharmacy. These pharmacies primarily serve as teaching and learning venues and provide services to the campus community and/or the community at large.

Drug information--the systematic approach: continuing education article.

Proper drug information (DI) skills are essential for being a competent pharmacy practitioner. To effectively manage DI queries and clinical dilemmas, the practitioner should follow a systematic approach that includes identifying the requester, determining the "true" DI need and obtaining background information, categorizing the question, performing the search and analyzing the information, disseminating the information, and following up when appropriate. The practitioner must be mindful to couple the published literature with clinical experience, knowledge, and logic in order to achieve optimal clinical outcomes.

Professional reading habits of pharmacists attending 2 educational seminars in New York City.

PURPOSE: Data regarding the professional reading habits of pharmacists in the United States are lacking. The purpose of this pilot study was to investigate whether pharmacists read professional publications and assess other aspects of their professional reading habits. METHODS: In December 2010, surveys were distributed to pharmacists participating in 2 educational seminars in New York City. The main outcome measures were percentages of pharmacists who read regularly (at least monthly), specific publications read, and the perceived value and impact of reading. RESULTS: A total of 184 pharmacists were surveyed. Of the 122 (66%) respondents, 112 (92%) reported reading professional publications regularly. Of these, 97 (87%) indicated the titles read, with the 4 publications reported most frequently being Drug Topics (n = 73; 75%), Pharmacy Times (n = 67; 69%), US Pharmacist (n = 60; 62%), and Pharmacist's Letter (n = 48; 49%). All 122 respondents indicated that reading positively impacted their practice, and 121 (99%) reported that reading was important. CONCLUSIONS: The value of reading professional publications was recognized by surveyed pharmacists; this likely contributed to the high reading rate reported in this study.

Functions performed by paid pharmacy interns in hospitals in New York.

PURPOSE: The types of clinical and nonclinical activities performed by paid pharmacy interns in the hospitals in New York state were studied. METHODS: In November 2008, a list of hospitals in New York was obtained from the website of the New York State Department of Health. A survey was sent to each hospital's pharmacy director requesting information on hospital characteristics and whether the pharmacy department employed nongraduate pharmacy interns. For those hospitals that employed pharmacy interns, questions were asked about the number of nongraduate pharmacy interns employed, the shifts worked by interns, whether there was a minimum work-hour requirement for interns, the functions routinely performed by interns, and the percentage of interns who remained employed at the hospital upon licensure. RESULTS: Of the 184 surveys distributed, 96 responses (52.2%) were received. The majority of hospitals had 400 beds or fewer and were teaching institutions, and 45 employed pharmacy interns. The five functions reported most frequently were answering telephone calls (91%), preparing and distributing medications (82%), compounding nonparenteral medications (69%), compounding parenteral medications (62%), and responding to drug information queries (51%). The mean ± S.D. number of clinical activities performed by interns was 2.1 ± 2.1. The most frequently reported clinical activities were responding to drug information queries (51.1%), performing clinical interventions (33.3%), and completing adverse-drug-reaction reports (31.1%). CONCLUSION: Hospital pharmacy departments in New York utilized paid pharmacy interns to perform a variety of functions, including clinical activities. While there appears to be recognition that interns can perform clinical activities, the mean number of such activities was relatively low.

Update on the status of 89 drug information centers in the United States.

PURPOSE: Previously identified U.S. drug information centers (DICs) were surveyed to determine whether they were still in existence and whether changes had occurred in the DICs since 2003. METHODS: Eighty-nine DICs identified in a 2003 survey were surveyed in April 2008. For DICs still in existence, questions were designed to determine whether there were changes in the mission, time spent on activities, staffing, and drug information questions (number, complexity, and time required to answer) compared with five years earlier. Respondents' projected need for their DIC over the next five years was also surveyed. RESULTS: Seventy-five (84%) of the 89 DICs were still active. The most notable changes in activities were increases in time spent on educating health-professions students (53%), supporting the institution's medication safety program (44%), and providing information-systems support (36%). The majority of respondents (73%) reported no change in the number of employed drug information personnel. The percentages of DICs reporting an increase, decrease, and no change in the number of drug information requests received were 29%, 42%, and 29%, respectively. Seventy percent reported an increase in the number of complex questions, while 53% reported an increase in the time required to answer each question. Ninety-seven percent of respondents projected no change or an increase in the need for their DIC over the next five years. CONCLUSION: Eighty-four percent of the previously identified DICs were still in existence. The most notable changes in these DICs were increases in the number of DICs focusing on educating health-professions students, the complexity of drug information questions, and the amount of time required to answer each request.

Patients' use and perception of medication information leaflets.

BACKGROUND: Federal law mandates that at least 95% of patients receive useful written information with new medications. Recent data concerning whether patients read such leaflets are lacking. OBJECTIVES: To evaluate whether patients read non-manufacturer-developed leaflets and assess patients' opinions concerning the understandability and usefulness of these leaflets. METHODS: Patients were surveyed at 32 community pharmacies in the New York City metropolitan area. The main outcome measures were the percentage of patients who read the leaflet provided with new and refilled medications and the perceived understandability and usefulness of the leaflet. Descriptive statistics were used to analyze the results. RESULTS: A total of 307 patients were surveyed. For leaflets provided with new medications, 151 (49.2%), 65 (21.2%), 49 (16.0%), and 42 (13.7%) reported reading the leaflets always, often, seldom, or never, respectively. For refilled medications, 64 (21.6%), 41 (13.9%), 78 (26.4%), and 113 (38.2%) of the 296 respondents reported reading the leaflets always, often, seldom, or never, respectively. Of 267 patients who read the leaflets provided with new or refilled prescriptions at least seldom, 258 (96.6%) responded to the question concerning its understandability and 257 (96.3%) responded to the question concerning its usefulness. One hundred forty-five (56.2%), 89 (34.5%), 22 (8.5%), and 2 (0.8%) reported that the leaflet was very easy, somewhat easy, somewhat difficult, and very difficult to understand, respectively, and 164 (63.8%), 90 (35.0%), and 3 (1.2%) reported that the leaflet was very useful, somewhat useful, and not useful, respectively. CONCLUSIONS: Approximately two-thirds of the patients surveyed reported reading the leaflets provided with new medications at least often. The majority reported the leaflets to be useful and easy to understand. Pharmacists should advocate reading the leaflet and promote it as a useful resource. The leaflet should not replace the pharmacist's obligation to provide verbal counseling.

Use of statins and gemfibrozil in patients with type 2 diabetes mellitus and cardiovascular risk factors attending adult day health care centers: an opportunity for pharmacists.

OBJECTIVE: Identify the extent of statin use for primary prevention of macrovascular complications, the extent of statin or gemfibrozil use for the secondary prevention of cardiovascular morbidity and mortality, and the statin doses used in patients with type 2 diabetes and other cardiovascular risk factors. DESIGN: Retrospective chart review. SETTING: Three adult day health care centers in Brooklyn and Queens, New York. PATIENTS: Patients with a diagnosis of type 2 diabetes and either a history of coronary artery disease or at least one other significant cardiovascular risk factor as defined by the American College of Physicians guidelines (i.e., age greater than 55 years, hypertension, left-ventricular hypertrophy, previous cerebrovascular disease, or peripheral arterial disease). MAIN OUTCOME MEASURES: Percentage of patients prescribed a statin for primary prevention of macrovascular complications of type 2 diabetes, percentage of patients prescribed a statin or gemfibrozil for secondary prevention of cardiovascular mortality and morbidity, and the percentage of patients on at least moderate doses of statins. RESULTS: Ninety-three patients were evaluated-51 in the primary-prevention group and 42 in the secondary-prevention group. In the primary-prevention group, 33 (64.7%) patients were prescribed a statin, while in the secondary-prevention group, 26 (61.9%) patients were on statins, a nonsignificant difference (P = 0.8308). No patients were prescribed gemfibrozil. Of all patients prescribed statins, 63.2% were at least on moderate doses. CONCLUSION: This study demonstrates suboptimal treatment with statins in patients with type 2 diabetes and cardiovascular risk factors.

Availability of and attitudes toward resources on alternative medicine products in the community pharmacy setting.

OBJECTIVE: To examine the availability of resources on dietary supplements in the community pharmacy setting and to assess the attitudes of community pharmacists toward these resources. DESIGN: Cross-sectional study. SETTING: Community pharmacies in New York and New Jersey that serve as experiential sites for senior student pharmacists at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University. PARTICIPANTS: Preceptors or full-time pharmacists. INTERVENTION: Mailed survey. MAIN OUTCOME MEASURES: Frequency of use, availability of, and pharmacists' satisfaction with resources on alternative medicines, defined in the survey as any product including herbal remedies, vitamins, minerals, and natural products that may be purchased at a health food store, pharmacy, supermarket, alternative medicine store/magazine for the purpose of self-treatment. RESULTS: A total of 64 pharmacists characterized their frequency of use of resources on alternative medicines while formulating responses to questions as: never (n = 5; 7.8%), seldom (n = 31; 48.4%), often (n = 24; 37.5%), or always (n = 4; 6.3%). A total of 30 different resources were available to 40 respondents. The most commonly available resources were the PDR for Herbal Medicines (42.5%), The Review of Natural Products (20.0%), and the Web site of the National Center for Complementary and Alternative Medicine (12.5%). Of 54 respondents, 4 (7.1%) reported being completely dissatisfied with the available resources; 17 (31.5%) were somewhat dissatisfied; 25 (46.3%) were somewhat satisfied; and 8 (14.8%) were completely satisfied with the resources available to them. Topics the pharmacists most commonly wanted to see improved included safety (72.7%), interactions (70.9%), and uses (69.1%). CONCLUSION: Community pharmacists do not use information resources on alternative medicine products frequently, and many are not satisfied with the resources available to them.

Current status of pharmacist-operated drug information centers in the United States.

PURPOSE: Pharmacist-operated drug information centers (DICs) in the United States and Puerto Rico were surveyed, and the results were compared with those of similar surveys conducted over the past 30 years. METHODS: In January 2003, surveys were mailed to 151 institutions that were thought to have an organized DIC, defined as a center that regularly accepts a broad scope of requests from health care professionals, regardless of the location or affiliation of those professionals. The survey covered such topics as affiliations, staffing, services, resources, quality assurance, involvement in education, and funding. RESULTS: One hundred nineteen DICs responded (79%), of which 81 met the criteria. Hospitals and medical centers and colleges and schools of pharmacy continued to be the most commonly reported affiliations. The number of DICs declined in the past decade, and the number of DIC pharmacists and other personnel was the lowest reported in the past 30 years. Drug information pharmacists appeared to be better trained than in the past, and a larger percentage had advanced degrees. Services provided by DICs remained consistent with previous findings, except for greater participation in the training and education of pharmacy students and residents. The resource most commonly reported by DICs as useful was Micromedex Healthcare Series, followed by MEDLINE and AHFS Drug Information. The percentage of DICs with formal quality assurance programs did not change significantly in the past decade. Funding sources and fee-for-service activities remained the same. CONCLUSION: The number of DICs has declined steadily since 1986, and the number of drug information pharmacists is at its lowest in 30 years. DIC services continue to be comprehensive. Only half of the DICs surveyed had a formal quality assurance program.