Burnout Among Health System Pharmacists: Presentation, Consequences, and Recommendations.

Burnout remains an emerging challenge in healthcare. Burnout in these settings has been associated with compromised personal wellbeing, decreased work productivity, higher healthcare costs, decreased patient satisfaction, and deteriorating quality of patient care. As pharmacist roles on healthcare teams expand, health-system pharmacy leaders should be cognizant of burnout, including risk factors and identification. Coordinated efforts should foster pharmacist wellbeing and resilience, individualized work-related responsibilities to ensure professional ambitions are met, promotion of upper leadership expectation transparency, and cultivation of relationships within the pharmacy department.

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections.

Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million.

Evolving Frontier: A Review of the Role of Mobile Medical Application Prescribing.

Objective: To describe the continuum of medical app prescribing. Data Sources: A review of literature was conducted using PubMed and MEDLINE. Search terms included medical app, prescribing, healthcare apps, medical phone apps, and mobile medical apps. Studies published in English from 2005 to December 2015 were included. Study Selection and Data Extraction: A total of 2264 articles were uncovered in the initial search. The publications included studies conducted in the United States and Europe within the past 10 years. Studies with a mobile app intervention were preferred. However, studies lacking a mobile app intervention were also included. No restrictions on the type of health application discussed in studies were chosen. Non-English language publications were excluded from the review. A total of 15 articles were selected based on the inclusion criteria and reviewer screening. Data Synthesis: The literature review identified that this is an area that requires further study to analyze the extent to which prescribers recommend apps for their patients. A concern over the lack of evidence in the effectiveness of the apps still remains. Prescribing mobile apps by providers to help keep track of their patients' symptoms and provide real-time advice on treatment and medication can be beneficial to control costs, reduce errors, and improve patients' experiences. Conclusion: The presence of mobile technology has enabled patients to become more engaged in the decision making regarding their health care. Additional resource allocation can be recommended to increase the quantity and quality of medical apps recommended by prescribers for their patients.

Comparative cost-effectiveness analysis of descemet stripping automated endothelial keratoplasty versus penetrating keratoplasty in the United States.

PURPOSE: To perform a comparative cost-effectiveness analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for corneal endothelial disease. DESIGN: Retrospective cost-effectiveness analysis. METHODS: This cost-effectiveness analysis was performed from a third-party payer perspective with a 5-year time horizon. Probabilities of outcomes and complications of each of the procedures were calculated based on review of the published literature. A model was constructed to compare the costs and utilities associated with DSAEK and PK. Costs of donor tissue preparation, surgery, follow-up, postoperative complications, and procedures were considered. Utility values were based on quality-adjusted life years associated with visual acuity outcomes. Both costs and utilities were discounted at 3% per year. Sensitivity analyses were performed on key model inputs. RESULTS: Base case analysis found DSAEK to be less costly compared with PK ($9362 vs $10 239), with greater utility (3.15 vs 2.47 quality-adjusted life years). Sensitivity analyses revealed that even at graft failure rates for DSAEK approaching the rates for PK, DSAEK would still reduce costs. Varying the dislocation rate in our model showed that even at dislocation rates approaching 50%, DSAEK remained less costly. Further, with DSAEK rejection rates as high as 28%, DSAEK would remain a dominant procedure over PK. CONCLUSIONS: Comparative cost-effectiveness analysis of DSAEK versus PK indicates favorable cost and utility outcomes associated with DSAEK for treatment of corneal endothelial disease. Longer follow-up of DSAEK outcomes will provide more accurate information regarding long-term cost-effectiveness of the procedure.

Impact of drug shortages on U.S. health systems.

PURPOSE: A study was performed to quantify the personnel resources required to manage drug shortages, define the impact of drug shortages on health systems nationwide, and assess the adequacy of information resources available to manage drug shortages. METHODS: An online survey was sent to the 1322 members of the American Society of Health-System Pharmacists who were identified as directors of pharmacy. Survey recipients were asked to identify which of the 30 most recent drug shortages listed affected their health system, to identify actions taken to manage the shortage, and to rate the impact of each shortage. Employees responsible for completing predefined tasks were identified, and the average time spent by each type of employee completing these tasks was estimated. Labor costs associated with managing shortages were calculated. RESULTS: A total of 353 respondents completed the survey, yielding a response rate of 27%. Pharmacists and pharmacy technicians spent more time managing drug shortages than did physicians and nurses. There was a significant association between the time spent managing shortages and the size of the institution, the number of shortages managed, and the institution's level of automation. Overall, 70% of the respondents felt that the information resources available to manage drug shortages were not good. The labor costs associated with managing shortages in the United States is an estimated $216 million annually. CONCLUSION: A survey of directors of pharmacy revealed that labor costs and the time required to manage drug shortages are significant and that current information available to manage drug shortages is considered suboptimal.