Methodology for conducting a comprehensive product review in managed care.

The high degree of complexity of the product-review process and differences in procedures between organizations have resulted in a need for best practices and an overall product-review process to create efficiencies for health care decision makers. In an effort to streamline product-review concepts, this article outlines the different components of the review process, including clinical and economic review, formulary placement determination, and evaluation of alternatives within a drug class. The article also details opportunities for the near future, as technology continues to advance and alignment between medical and pharmacy benefits is desired. DISCLOSURES: Drs Linnerooth, Penley, Ha, and Craven report employment with Xcenda, which provided funding for the manuscript. Drs Sauvageau and Hydery report employment Xcenda, which provided funding for the manuscript, and stock holdings with AmerisourceBergen. Dr Feeney reports support for attending meetings and/or travel provided by Highmark, Inc. Dr Thomas reports receipt of consulting fees from ActiveRADAR, board member roles with ActiveRADAR and RoundtableRx, an adjunct professor role with the University of Minnesota, and stock options and pensions with Eli Lilly and Aetna/CVS. Dr Watkins reports payment or honoraria from ISPOR and for articles written for Value and Outcomes Spotlight, and support for attending meetings and/or travel by AMCP.

Advancing a managed care pharmacy research agenda: Generating real-world evidence to support US Food and Drug Administration Accelerated Approvals and improving benefit design to address health inequities.

To advance their research agenda, the Academy of Managed Care Pharmacy (AMCP) and the AMCP Foundation (AMCPF) invited a sample of AMCP membership to participate in focus groups and tasked them with developing tangible research aims for each of the top 2 previously identified AMCP/AMCPF research priorities: generating real-world evidence (RWE) to support US Food and Drug Administration (FDA) Accelerated Approvals and improving benefit design to address health inequities. The resulting research aims, which were further refined per feedback from additional stakeholders, will serve to guide requests for proposals for funding of specific research projects to address these top managed care priorities. Research aims identified by focus group participants related to generating RWE for FDA Accelerated Approvals include (1) creating a data survey tool for managed care to make RWE more readily available, (2) linking surrogate endpoints to meaningful clinical outcomes for drug development, and (3) improving patient outcomes by determining the optimal sequence of clinical pathways. Research aims identified by focus group participants related to improving benefit design to address health inequities include (1) identifying how the ability to navigate managed care benefit designs may impact inequities, (2) understanding the connection between health inequities and medication adherence, and (3) evaluating the impact of social determinants of health on medication affordability. DISCLOSURES: These proceedings were supported by Bridget Flavin, PharmD, Founder, Connected Content, Ltd. Connected Content, Ltd. received payment from AMCP for the preparation of this manuscript. Flavin is also an adjunct associate professor at the University of Florida College of Pharmacy. Diana Brixner received AMCP Foundation support of sabbatical to conduct this work, support of a medical writer to assist in putting the manuscript together, consulting fees from Millcreek Outcomes Group, Elevar, Sage, Haymarket, and AMCP funding of one trip to Alexandria, VA. This research and the development of this manuscript were funded by AMCP and the AMCP Foundation.

Learning the Chymical Compromise: Paracelsian and Galenic Medicine in Marburg Disputations on Chymiatria.

The chair of chymiatria created at the University of Marburg was among the earliest academic initiatives aiming to integrate chymistry into the medical curriculum. If its practical applications in pharmacy and its relationship with patronage have been examined by historians, the theoretical part of the chymiatria programme still remains to be explored. In the form of student disputations and dissertations held or presided over by Heinrich Petraeus, a professor of medicine at Marburg and Johannes Hartmann's son-in-law, "chymiatric" essays expounded various medical issues. Centred on pathology, therapy, and physiology, these theoretical explanations proposed a "hermetic-dogmatic" interpretation merging the views of Paracelsus and Galen. This article examines these disputations and their stance concerning the living body, sickness, and treatment, and how they shaped the status of chymistry as an art and a science on the verge of institutionalisation.

Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study.

BACKGROUND: Globally, the safety of patients and healthcare providers is at risk due to health care-associated infections (HCAIs). World Health Organization and the Centers for Disease Control and Prevention recommend using alcohol-based hand rub (ABHR) for hand hygiene in healthcare settings to prevent HCAIs. Irrational use of ABHR will have undesirable consequences including wastage of products, exposure of healthcare providers to infections and emergence of microbial resistance to the alcohol in hand sanitizers. This study aimed to explore the perspective and experiences of compounding pharmacists on production and utilization of ABHR solution for coronavirus disease in 2019 (COVID-19) prevention in public hospitals of Addis Ababa, Ethiopia. METHODS: A descriptive qualitative study using in-depth interview of 13 key-informants serving as compounding pharmacists in public hospitals of Addis Ababa, Ethiopia, was conducted. The study participants were identified and selected by purposive sampling. All transcribed interviews were subjected to thematic analysis and transcripts were analyzed manually. FINDINGS: The compounding pharmacists in this study had a mean age of 30.6 (±3.1) years and nine of the thirteen participants were men. Ten participants believed that the compounding practice in their respective sites followed the principles of good compounding practice. More than half of the participants did not believe that ABHR products were used rationally in health facilities. They argued that users did not have enough awareness when and how to use sanitizers. Most of the interviewees reported that compounding personnel had no formal training on ABHR solution production. Study participants suggested incentive mechanisms and reimbursements for experts involved in the compounding of ABHR solutions. CONCLUSION: Three of the compounding pharmacists indicated that ABHR production in their setting lack compliance to good compounding practice due to inadequate compounding room, quality control tests, manpower and equipment. Despite this, most study participants preferred the in-house ABHR products than the commercially available ones. Thus, training, regular monitoring and follow-up of the hospital compounding services can further build staff confidence.

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.

Assessing the Relationship Between Didactic Performance and Standardized Examination Scores in Pharmacy Students.

Objective. To examine the effect size of third professional (P3) year students' grade point average (GPA) on Pharmacy Curriculum Outcomes Assessment (PCOA) scores and to summarize the effect size of PCOA scores on North American Pharmacist Licensure Examination (NAPLEX) scores. Methods. To accomplish the objective, meta-analyses were conducted. For inclusion in the meta-analysis, studies were required to compare PCOA scores to and report data that permitted calculation of a numeric effect size for the chosen outcome variables. Multiple databases were searched, including PubMed, CINAHL, EMBASE, ProQuest Dissertations and Thesis (abstract limited), Academic Search Complete, and Google Scholar. Correlations were used as the effect size metric for all outcomes. All analyses used an inverse variance weighted random effects model. Study quality was reviewed for each study included in the meta-analyses. Results. This study found that PCOA scores were moderately correlated with P3 GPAs, accounting for 14% to 48% of the variability in PCOA scores. The meta-analyses also showed that PCOA scores were moderately correlated with NAPLEX and accounted for 25% to 53% of the variability in NAPLEX scores. Both meta-analyses showed a high degree of heterogeneity and many studies included were of low quality. Conclusion. This first set of meta-analyses to be conducted on the PCOA showed that third professional year GPA does correlate with PCOA results and that PCOA scores correlate with NAPLEX results. Though there are significant limitations to interpretation of the results, these results do help further elucidate the role of the PCOA as a benchmark of progress within the pharmacy curriculum.

Study Behaviors Associated with Student Pharmacists' Academic Success in an Active Classroom Pharmacy Curriculum.

Objective. To identify the specific study behaviors that promoted student pharmacists' success in an active-learning pharmacy curriculum. Methods. The Washington State University College of Pharmacy and Pharmaceutical Sciences implemented an active-learning, flipped classroom model for instruction to equitably deliver course content to Doctor of Pharmacy students on both its main and extended campuses. Students' ability to adapt to the new model and its impact on their study behaviors were unknown. A qualitative descriptive design that included semi-structured interviews was applied to evaluate the study behaviors of high-performing students. The study sample included 13 third and fourth professional year pharmacy students in the top 20% of their respective classes. Results. Interview responses were unaffected by baseline demographics such as gender and year of graduation. Content analysis generated five primary themes related to the behavioral strategies used by high performers: preparing for class, preparing for testing, seeking help, knowing yourself, and building on strengths. These were mapped to the four tenants of Wenger's social learning theory in the representation of findings: learning as doing, learning as belonging, learning as becoming, and learning as experience. Conclusion. High-performing students demonstrated a refined ability to select and modify study behaviors that aided in their academic success, demonstrating a high degree of metacognition. The results of this research may assist pharmacy faculty members in identifying critical elements for success of students enrolled in pharmacy programs using an active learning model.

Use of Learning Style Frameworks in Health Science Education.

Objective. To review the literature regarding the use of learning style frameworks in health science education, with particular attention to learning outcomes and use for self-awareness. Findings. Of the 415 articles identified in an initial search of the literature, 31 articles involving learning style frameworks were included after screening titles, abstracts, and full texts. Multiple learning style frameworks, including VARK, Kolb Learning Style Inventory, Honey and Mumford Learning Style Questionnaire, and Pharmacist Inventory of Learning Styles, have been used in various health science education disciplines, including medicine, nursing, and pharmacy. Most publications were descriptive in nature, reporting the learning styles of the given student cohort. Most studies that attempted to find a correlation between learning style and learning outcomes found none. In cases where a correlation was found, it was weak or inconsistent with findings from other published studies. No identified studies described use of learning style frameworks for increasing self-awareness in learners. Summary. While several different learning style inventories have been used to assess health science education students, their utility for predicting learning outcomes appears to be weak. Using learning style inventories to improve learner self-awareness is an unexplored area of education and research.

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.

Using Artifacts and Qualitative Methodology to Explore Pharmacy Students' Learning Practices.

Objective. To explore the use of artifacts and material objects in accessing what learning means to pharmacy students, what their learning practices are, and their assumptions about what it means to master the pharmacy curriculum. Methods. Data collection was qualitative and took the form of individual semi-structured interviews with students in a Master of Pharmacy program. Participants were asked to select three artifacts (a photograph, an object, a song, a picture, or something else) that represented what learning as a pharmacy student meant to them and bring them to the interview. The interviews were conducted using both the abstracts and a semi-structured interview plan constructed as a mind map. Flexibility was applied to changing the sequence of themes, and additional probing questions were asked. Data were analyzed thematically using mind mapping and, subsequently, theoretical constructs were applied to make sense of the analysis. Results. Nineteen interviews were conducted. Findings were grouped into five distinct themes: study practices or strategies adopted, rituals associated with learning and studying, pharmacy knowledge, motivation for learning, and ways of learning. Each of these identified themes was summarized and illustrations from the data given. The affective dimensions of learning were a strong emergent theme throughout the data. Conclusion. The use of artifacts in the research process afforded in-depth insight into the specific study practices adopted by a group of pharmacy students. Qualitative methods can be useful in surfacing students' learning practices and difficulties faced in their negotiation of the pharmacy curriculum.

Overview and Prospect of Autoethnography in Pharmacy Education and Practice.

Objective. To provide an overview of autoethnography as a valuable qualitative methodology in the human and health sciences and to endorse its use to answer meaningful research questions in pharmacy education and assist with the preparation of person-centered pharmacists. Findings. Today, pharmacists must participate in the health care system as care providers rather than simply drug dispensers. The call for change, which began with the evolution of clinical pharmacy and continued with the introduction of pharmaceutical care practice in the 1990s, is still proving to be dramatic for the profession. Thus, new problems are surfacing demanding new types of research questions and new ways of answering them. Autoethnography is a qualitative methodology that combines the principles of ethnography and autobiography in a way that highlights researchers' reflexivity and subjectivity. The paper describes autoethnography, its diverse forms (eg, evocative or analytical), the process of producing it, and associated standards of high-quality work. It presents autoethnographies carried out in health care research as well as in pharmacy, pointing to the usefulness of this methodology to produce meaningful investigations that can enrich the preparation of future pharmacists and advance the profession. Summary. Autoethnography is gaining recognition in many disciplines in health care. Even though it is still incipient in pharmacy, autoethnography can expand pharmacy students' and pharmacists' consciousness regarding their own situation and open the possibility for pursuing research that might enhance the lives of others and themselves.

Exploring the Impact of Participating as Pharmacy Camp Counselors on Student Pharmacists' Professional Identity.

Objective. To explore how participation as a pharmacy camp counselor impacted pharmacy students' professional identity and views on professionalism. Methods. A pharmacy camp was developed to introduce rising high school juniors and seniors to the pharmacy profession. First- and second-year student pharmacists were invited to serve as counselors and, afterward, to participate in a focus group to share their experiences. Researchers used the focus group data to explore the impact of the camp experience on the student pharmacists. A direct interpretation approach was used to examine data as it allowed the research team to assess this single instance and draw meaning from focus group findings. Categories/themes were constructed through the interpretations of patterns and relationships discovered within the deconstructed results. Results. Ten student pharmacists participated in the focus group. The students provided their perspectives on the camp experience, including their role as camp counselors, the campers attending the camp, and the differences observed between student pharmacists and non-pharmacy camp counselors. Student pharmacists' comments gravitated toward the topic of professionalism. Student pharmacist counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts. Conclusion. Inclusion of student pharmacists in leadership roles such as this proved to be an effective means for further developing professional attributes. The focus group feedback provided novel insights into the professional mindset of student pharmacists. After serving as camp counselors, student pharmacists described their new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists.

An Applied Improvisational Pharmacy Communication Workshop Implemented During Orientation for First-Year Pharmacy Students.

Objective. To deliver a brief, applied workshop in improvisational communication skills during the new student orientation for first-year Doctor of Pharmacy students and to assess students' perceptions about the experience. Methods. Communication instructors developed a two-hour communication "boot camp" based on established principles of clear, responsive, flexible communication. They taught core skills through interactive applied improvisational exercises and facilitated debriefings. A questionnaire was administered following the workshop that asked students to rate the quality of the session and comment on its strengths and weaknesses. Results. Of the 124 students who participated in the workshop, 95 (77%) completed evaluations at the end. Their feedback was generally favorable: 90% of participants indicated that the boot camp improved their communication skills and 92% agreed that the activities were realistic and relevant to real-life scenarios. The students reported that they valued the chance to connect with classmates, learn how to adapt to different audiences, and explore how communication skills would be useful in professional settings. Conclusion. This interactive program delivered valuable content in a short period of time. Student feedback suggested that they valued the expertise of communication instructors and the playful, active method of learning. The creation of the workshop was labor-intensive because of the formative research that guided it.

Appropriateness of Term Limits for Administrative Appointments in Pharmacy Programs.

The appropriateness of term limits for administrative appointments is a subject of much discussion, not just within pharmacy programs, but in organizations of all types. The prospect of term limits for involves a wide variety of important organizational issues, including succession planning, institutional memory, strategic decision-making, and concepts regarding leadership styles overall. This paper examines both sides of the debate regarding the appropriateness of term limits for administrative appointments. Arguments supporting term limits include the ability for strategic changes in the diversity of leaders as well as a more focused effort on continuous quality improvement. The arguments against term limits focus around the need for stability and the time involved in the development of effective leaders.

Changes in Pharmacy Students' Metacognition Through Self-Evaluation During Advanced Pharmacy Practice Experiences.

Objective. To explore whether metacognition can be improved in Doctor of Pharmacy (PharmD) students through routine self-assessment over a year-long advanced pharmacy practice experience (APPE) sequence. Methods. Differences between self-assessment scores and preceptors' scores for three cohorts of pharmacy students between 2015 and 2018 were compared between the first, second, and third trimester to determine whether students more accurately evaluated their performance over time. The primary endpoint was change in the absolute difference between student and preceptor evaluation (rubric and composite scores) between trimesters. Results. Of 2577 student and preceptor evaluations eligible for inclusion, 1713 were completed, matched, and analyzed. Using the same rubric as preceptors, students overestimated their performance by an average of 16 points during the first trimester, followed by 14 and 12 points during the second and third trimester, respectively. This reflected a significant improvement over time. No significance difference was found between student and preceptor composite scores. Faculty preceptorship, students' pre-APPE grade point average, and type of APPE were not associated with any difference in rubric or composite scores. Conclusion. This analysis revealed that the difference between student self-evaluation grades and preceptor evaluation grades was greatest during the first trimester and significantly decreased in the second and third trimesters. This could reflect students' development of metacognitive processes over time. Metacognition is a vital skill for pharmacy students to learn, and opportunities to develop this skill should be incorporated throughout the pharmacy curricula.

Assessment of burnout within a health-system pharmacy department.

PURPOSE: Workplace-related burnout is a state of mental and physical exhaustion caused by one's professional life. Literature demonstrates the link between physician burnout and serious consequences (reduced productivity, medical errors, and clinician suicide), but assessment of burnout in other healthcare professions is limited, especially in pharmacy. A quality improvement study was conducted to quantify burnout in a diverse health-system pharmacy department and identify potential strategies to improve well-being. METHODS: A survey was distributed to assess the perception and drivers of burnout within a health-system pharmacy. All associates received a survey comprised of the Maslach Burnout Inventory (MBI), demographic questions, and items affording respondents the opportunity to list stressors and potential solutions. Email reminders were sent weekly and site visits were conducted to encourage survey completion. Results were analyzed via descriptive statistics. RESULTS: Two hundred seventy-seven associates completed the survey (response rate, 40.5%). Seventy percent of those participants were experiencing moderate to high levels of burnout, with survey results indicating moderate levels of personal accomplishment and emotional exhaustion and low levels of depersonalization; there were no statistically significant differences in mean MBI scores by shift type, hours worked per week, or years of service. There were statistically significant differences in scores for personal accomplishment between males and females, as well as among positions and regions (P < 0.05). Participants identified issues related to workflow, control, and community as the greatest contributors to stress. CONCLUSION: The diverse staff of a health-system pharmacy department reported a moderate amount of burnout, with the greatest variation in the dimension of personal accomplishment. The mitigation strategies most commonly cited were staffing/workflow adjustments and creating a culture of well-being.

Women in oncology pharmacy leadership: A white paper.

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA's strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.