bluuebunny/crossref_metadata_2025 huggingface dataset:
PARTICIPAÇÃO SOCIAL NO SISTEMA ÚNICO DE SAÚDE: O ENVOLVIMENTO DA POPULAÇÃO DE ALAGOINHAS
Authors: Oliveira Rosalvo de Jesus , Brito Lima Wilza Carla Mota
Published: January 2018

O presente trabalho é uma reflexão sobre a participação social no Sistema Único de Saúde. O objetivo foi analisar a participação da população de Alagoinhas, Bahia, no Sistema Único de Saúde. Para isso, optou-se por uma pesquisa qualitativa, utilizando roteiros semiestruturados aplicados a seis trabalhadores e oito usuários do referido sistema, nas áreas de abrangência de duas unidades de saúde da família e seis conselheiros municipais. Os dados empíricos revelaram que a população em análise não participa ativamente do Controle Social no Sistema Único de Saúde e que o Conselho Municipal de Saúde é pouco atuante em seu papel deliberativo frente às demandas de saúde do município. Concluiu-se que a participação popular no Sistema Único de Saúde em Alagoinhas, Bahia, não é apoiada pelos Gestores de Saúde na formulação de uma política que a incentive, bem como não há uma articulação que dê suporte aos Conselhos Municipais de Saúde, para que possam desempenhar suas ações de forma significativa.

Palavras-chave: Controle Social. Participação popular. Sistema Único de Saúde.
SOBREPESO E OBESIDADE INFANTIL: CONHECIMENTOS E PERCEPÇÕES DOS PROFESSORES DE CRECHES PÚBLICAS
Authors: FECHINE ALVARO DIOGENES LEITE , MACHADO MÁRCIA MARIA TAVARES , LINDSAY ANA CRISTINA , CARDOSO MARLY AUGUSTO , BEZERRA JOSÉ ARIMATÉA BARROS , ARRUDA CARLOS ANDRÉ MOURA
Published: January 2018

A obesidade e o sobrepeso em crianças vêm se tornando um sério problema de saúde pública no Brasil e no mundo, afetando crianças de todas as idades, classes sociais, raças e etnias. Objetivou-se identificar o conhecimento e a percepção de professores de creches públicas sobre o sobrepeso e a obesidade infantil e as implicações de tais alterações de peso na prática diária. Tratou-se de pesquisa qualitativa que utilizou a técnica do grupo focal com 14 professores da zona rural e urbana de um município cearense. O processamento desse material foi conduzido pela análise do discurso. Os resultados apontaram que os professores apresentaram-se como fortes aliados no desenvolvimento de estratégias que visaram à educação alimentar e ao estímulo de hábitos de vida saudáveis, compreendendo que existe uma correlação positiva entre aluno saudável, peso adequado e alimentação correta. Ao lado disso, reclamaram da baixa preocupação dos pais em relação aos aspectos da educação dos filhos matriculados. Concluiu-se que professores de creches públicas conheciam e percebiam o sobrepeso e a obesidade como problemas de saúde e reconheciam que simples ações que envolvessem a participação conjunta entre pais, professores e profissionais da saúde podiam ser de grande valia para o início de práticas alimentares e de vida mais saudáveis.

Palavras-chave: Transição nutricional. Obesidade. Sobrepeso. Creches.
ANALISIS KELAYAKAN EKONOMI BERBAGAI SISTEM SADAP PADA PANEL BO TANAMAN KARET (STUDI KASUS KEBUN BATUJAMUS JAWA TENGAH)
Authors: Widyasari Titik , Nugrahani Mudita Oktorina , Rouf Akhmad , Setya Aji Yoga Bagus , Rinojati Nofitri Dewi
Published: January 2018

Fluktuasi harga karet merupakan fenomena yang tidak dapat dihindari, namun pebisnis karet senantiasa berusaha bertahan agar biaya produksi rendah dan produktivitas kebun meningkat. Salah satu usaha yang dilakukan adalah penurunan frekuensi sadap. Penelitian ini bertujuan untuk menganalisis kelayakan ekonomi berbagai sistem sadap di panel BO dengan variasi frekuensi sadap dan stimulansia yang diharapkan mampu menurunkan biaya penyadapan dan penggunaan tenaga penyadap. Penelitian dilaksanakan di Kebun Batujamus milik perusahaan negara mulai Oktober 2015 hingga Oktober 2016. Penelitian disusun dengan Rancangan Acak Kelompok Lengkap dengan 11 perlakuan  sistem sadap dan 3  ulangan. Analisis anggaran parsial digunakan untuk menilai kelayakan ekonomi. Hasil penelitian menunjukkan bahwa sistem sadap yang  layak untuk diterapkan adalah sistem sadap S/2d3.ET2.5%.Ga.1.m/3, S/2 d3.ET2.5%.Ga.1.2w, S/2 d3.ET4.0%.Ga.1.2w, S/2 d4.ET4.0%.Ga.1.2w dan S/2 d4.ET5.0%.Ga.1.2w.  Adapun  sistem sadap S/2 d3.ET5.0%.Ga.1.2w, frekuensi sadap d5 dan d6 tidak layak secara ekonomi.
Desacoplamiento para Sistemas Continuos en el Tiempo mediante la Técnica Matriz Función de Transferencia
Authors: Granizo Montalvo Evelio Alfredo , Ayala Taco Jaime Paúl , Barragán Marco
Published: January 2018

En los sistemas de control multivariables se disponen de varias entradas y varias salidas, donde cada entrada controla más de una salida y cada salida es controlada por más de una entrada, lo cual se denomina acoplamiento, que presenta complicaciones matemáticas para su resolución, lo que dificulta el control de este tipo de sistemas. Este trabajo tiene como objetivo el desarrollo de una técnica de desacoplamiento por matriz función de transferencia para sistemas multivariables de múltiples entradas y salidas, que consiste en determinar un compensador, de tal forma que el sistema acoplado multivariable pueda convertirse en un desacoplado de varios sistemas de una  entrada y una salida. Esto permite que cada entrada controle solamente una salida y que cada salida sea controlada por una entrada; lo que facilita la solución del control. El sistema propuesto utiliza una  metodología computacional para lograr el objetivo planteado. Para demostrar la eficacia del algoritmo propuesto se realiza una validación experimental mediante simulaciones matemáticas de diferentes plantas de prueba.
“No debemos abdicar de todo lo que ha avanzado la reflexión histórica en aras de la popularidad”: dinámicas historiográficas, relatos y contrarrelatos en España. Una entrevista a Juan Pan-Montojo
Authors: Carini Gabriel Fernando
Published: January 2018

Entrevista
Inviting Scholarship in Leadership in Pharmacy
Authors: Sorensen Todd D. , Traynor Andrew P. , Janke Kristin K.
Published: January 2018

Type: Invitation
Will Translational Science Help Reduce Costs of Illness?
Authors: Kockaya Guvenc , Wertheimer Albert I.
Published: January 2018

The purpose of this commentary is to (1) review the definition and potential benefits of translational science research, (2) comment on funding trends for translational science, (3) pose a question for scientists to discuss, and (4) propose recommendations for such a discussion.

Type: Commentary
Pharmacist Contributions to the U.S. Health Care System
Authors: Schommer Jon C. , Planas Lourdes G. , Johnson Kathleen A. , Doucette William R. , Gaither Caroline A. , Kreling David H. , Mott David A.
Published: January 2018

Objective: The overall goal for this study was to conduct a segment analysis of the pharmacist workforce during 2009 based upon time spent in medication providing and in patient care services.

Methods: Data for this study were obtained from the 2009 National Pharmacist Workforce Survey in which a random sample of 3,000 pharmacists was selected. Cluster analysis was used for identifying pharmacist segments and descriptive statistics were used for describing and comparing segments.

Results: Of the 2,667 surveys that were presumed to be delivered to a pharmacist, 1,395 were returned yielding a 52.3% overall response rate. Of these, 1,200 responses were usable for cluster analysis. Findings from this study revealed five segments of pharmacists: (1) Medication Providers, (2) Medication Providers who also Provide Patient Care, (3) Other Activity Pharmacists, (4) Patient Care Providers Who also Provide Medication, and (5) Patient Care Providers. The results showed that, in 2009, 41% of U.S. pharmacists were devoted wholly to medication providing (Medication Providers). Forty-three percent of pharmacists contributed significantly to patient care service provision (Medication Providers who also Provide Patient Care, Patient Care Providers who also Provide Medication, and Patient Care Providers) and the remaining 16% (Other Activity Pharmacists) contributed most of their time to business / organization management, research, education, and other health-system improvement activities.

Conclusions: Based on the findings, we propose that the pharmacy profession currently has, and will continue to build, capacity for contributing to the U.S. health care system in new roles for which they have been identified. However, as shifts in professional roles occur, a great deal of capacity is required related to new service provision. Resources are scarce, so an understanding of the most appropriate timing for making such changes can lead to cost-effective use of limited resources for improving patient care.

Type: Original Research
Science, Innovation, and Innovation in the Science of Pharmacy
Authors: Cline Richard R. , Worley Marcia M. , Westrick Salisa C. , Schommer Jon C.
Published: January 2018

Type: Invitation
"N of 1, Footprints and Webs": Foundation of Managed Care Pharmacy
Authors: Thomas Norrie
Published: January 2018

Type: Idea Paper
Assessment of patient perceptions concerning a community pharmacy-based warfarin monitoring service
Authors: Waitzman Jennifer , Hiller Debbie Pruss , Marciniak Macary Weck , Ferreri Stefanie
Published: January 2018

Objective: To assess patient perceptions of a North Carolina community pharmacy-based warfarin monitoring service.

Methods: Prospective study of patients 18 years of age and older, who filled a prescription for warfarin, in one of five Raleigh area community pharmacies, between May 1, 2010 and October 31, 2010. A 14 item survey, along with a self-addressed stamped envelope, was mailed to 330 identified patients. The survey inquired about details of current anticoagulation monitoring services, interest in utilizing a local community pharmacy for this service, and confidence in a pharmacist-managed program.

Results: 26% of surveys were returned. 48% of surveyed individuals responded that they would be interested in having their warfarin monitoring performed by a trained pharmacist in a community pharmacy setting.

Conclusion: Many participants responded that the community pharmacy would be more convenient than or as convenient as their current location. This may be a new clinical service that could be offered in certain community pharmacies.

 

Type: Original Research
Extent of Drug Coverage across Generic Drug Discount Programs offered by Community Pharmacies: A look at five Chronic Conditions
Authors: Patel Harshali K. , Akinwunmi Peter O. , Sansgiry Sujit S.
Published: January 2018

Background: Chronic conditions are expensive to treat because of the ongoing prescription cost burden. Generic drug discount programs (GDDPs) that offer generics at discounted price may prove beneficial to reduce pharmacy costs for the same.

Objective: The objective of this study was to assess the extent to which GDDPs provide drug coverage for five common chronic conditions.

Methods: A content analyses of preexisting information was conducted. Extent of coverage based on top 200 generic drugs prescribed during 2008 for the treatment of chronic conditions such as hypertension, mental disorders, arthritis, pulmonary/respiratory conditions, and diabetes were identified. Commonly prescribed medications for these diseases were identified using published peer reviewed clinical guidelines. List of drugs covered under a GDDP for stores, Wal-Mart, Walgreens, CVS, Kroger, HEB, Target, and Randalls were obtained and compared to assess drug coverage by retail dollar sales and sales volume. Descriptive statistics and frequency/percentage of coverage were reported using SAS 9.2.

Results: GDDPs covered the highest number of drugs for hypertension (21-27 across different GDDPs) and the least (3-5 across different GDDPs) for pulmonary/respiratory conditions. Arthritis (5-11), mental disorders (6-11) and diabetes (5-7) had similar coverage. When compared to the top 200 drugs by retail dollars spent during 2008, hypertension (68%-87%) and diabetes (63%-88%) had the highest coverage followed by respiratory conditions (30%-50%), arthritis (22%-48%), and mental disorders (21%-38%). Similar result was obtained when GDDP coverage was compared with the top 200 generic drugs by sales volume, where diabetes (63-88%) and hypertension (57%-74%) had the highest coverage and mental disorders remained the lowest (23%-37%).

Conclusion/Implications: Drug coverage in GDDPs varied by pharmacies across the five common chronic conditions evaluated which may limit accessibility of these programs for uninformed consumers. Drug coverage was higher for diabetes and hypertension compared to mental disorders, arthritis, and pulmonary/respiratory conditions. Innovative strategies such as a national GDDP formulary list or internet-based technological tools to help consumers identify comparative drug coverage may be useful to improve access to these medications.

 

Type: Student Project
The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic
Authors: Vanmali Radha S , Mayer Sallie D , Fugit Ann M
Published: January 2018

Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV) clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit.

Design: Retrospective, single-centered, chart review.

Setting: Free, bilingual clinic in Richmond, VA.

Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011.

Main Outcome Measure: Types of interventions documented during the patient-pharmacist visit, categorized as medication review, patient education, or adherence monitoring.

Results: Total of 32 patients accounted for 55 patient-pharmacist visits and 296 interventions. The most common interventions were medication review (66.9%), patient education (23.3%), and adherence monitoring (9.8%). Post-hoc analysis suggests Hispanic patients are more likely to be diagnosed with Acquired Immune Deficiency Syndrome (AIDS) (P = 0.01), have current or history of opportunistic infection (OI) (P=0.01), and have current or history of OI prophylaxis (P = 0.03). Adherence monitoring was less common amongst the non-Hispanics (7.1%) compared to the Hispanic sub-population (16.5%), (P = 0.04).

Conclusion: The role of ambulatory care pharmacists in a free and bilingual clinic goes beyond adherence monitoring. Pharmacists can be a valuable part of the patient care team by providing medication review and patient education for HIV and other co-morbidities within free clinics. Further research is warranted to assess outcomes and to further explore the underlying barriers to early HIV diagnosis and adherence within the Hispanic population.

 

Type: Original Research
Drug shortage management in Alabama hospital pharmacies
Authors: Holmes Oliver W. , Hughes Peter J.
Published: January 2018

Purpose: The purpose of this study is to identify effective strategies used by Alabama hospitals to manage drug shortages. Moreover, this study aims to determine if there are any relationships among hospital size, utilization of a standard policy for drug shortage management and perceived usefulness of standard procedures for drug shortages.

Methods: A paper survey was mailed to 129 hospital pharmacies in Alabama (per the Alabama Hospital Association directory). The survey consisted of 5 demographic questions, questions involving perception of current medication shortages, sources of information about shorted drugs, and frequency of discussion at P&T committee meetings. Most importantly, the survey contained questions about the use of a standard policy for handling drug shortages, the effectiveness of the policy if one is used, and an open-ended question asking the recipient to describe the policy being used.

Results: A response rate of 55% was achieved as 71 surveys were completed and returned. Approximately 70% of the survey respondents described the current drug shortage issue as a top priority in their pharmacy department. The pharmacy distributor served as the primary source of information regarding drug shortages for 45% of the facilities. There is a direct relationship between size of hospital and likelihood of utilization of a standard policy or procedure for drug shortage management among the sample. The smaller facilities of the sample perceived their management strategies as effective more frequently than the larger hospitals.

Conclusion: Common components of effective management strategies included extensive communication of shortage details and the ability to locate alternative products. The use of portable technology (e.g., Smart phones and tablets) along with mobile applications may emerge as popular means for communicating drug product shortage news and updates within a facility or healthcare system.

 

Type: Original Research
Transitions in Care: Medication Reconciliation in the Community Pharmacy Setting After Discharge
Authors: Freund Jeff E. , Martin Beth A. , Kieser Mara A. , Williams Staci M. , Sutter Susan L.
Published: January 2018

Objective: To assess the feasibility of a workflow process in which pharmacists in an independent community pharmacy group conduct medication reconciliation for patients undergoing transitions in care.

Methods: Three workflow changes were made to improve the medication reconciliation process in a group of three independent community pharmacies. Analysis of the process included workflow steps performed by pharmacy staff, pharmacist barriers encountered during the medication reconciliation process, number of medication discrepancies identified, and pharmacist comfort level while performing each medication reconciliation service.

Key Findings: Sixty patient medication reconciliation services met the inclusion criteria for the study. Pharmacists were involved in all steps associated with the medication reconciliation workflow, and were the sole performer in four of the steps: verifying discharge medications with the pharmacy medication profile, resolving discrepancies, contacting the prescriber, and providing patient counseling. Pharmacists were least involved in entering medications into the pharmacy management system, performing that workflow step 13% of the time. The most common barriers were the absence of a discharge medication list (24%) and patient notpresent during consultation (11%). A total of 231 medication discrepancies were identified, with an average of 3.85 medication discrepancies per discharge. Pharmacists' comfort level performing medication reconciliation improved through the 13 weeks of the study.

Conclusions: These findings suggest that medication reconciliation for patients discharged from hospitals and long term care facilities can be successfully performed in an independent community pharmacy setting. Because many medication discrepancies were identified during this transition of care, it is highly valuable for community pharmacists to perform medication reconciliation services.

 

Type: Original Research
Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population
Authors: Kelling Sarah E. , Bright David R. , Ulbrich Timothy R. , Sullivan Donald L. , Gartner James , Cornelius Douglas C.
Published: January 2018

Objective: To describe successes and barriers with the development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population.

Setting: A single supermarket chain pharmacy

Practice description: Community pharmacists provide dispensing and non-dispensing pharmacy services including medication therapy management, biometric wellness screenings, and immunizations.

Practice innovation: Developed and implemented a community pharmacy medication therapy management-based transition of care program for patients with managed Medicaid

Main outcome measures: Feasibility of developing and implementing a transition of care service in a community pharmacy

Results: During the first six months, a total of 17 patients were seen as part of the program. Study pharmacists identified successes and potential strategies for overcoming barriers.

Conclusion: Developing and implementing a community pharmacy transition of care program for patients with managed Medicaid was logistically feasible.

 

Type: Original Research
Needle free injection technology - An overview
Authors: Kale Tejaswi R. , Momin Munira
Published: January 2018

Needle free injection technology was developed to reduce the number of needle stick accidents and associated problems. A comprehensive literature review was completed regarding needle free injection technology and its applications, advantages over needle injections, their components and types such as powder injection, liquid injection, depot or projectile injection. This review describes needle free injection technology involving the generation of force by using compressed gas upon actuation in order to deliver a drug at very high speed through a nozzle. This review also describes injection methods that use a spring load jet injector, battery powdered jet injector, and gas powdered jet injector. An overview of marketed products, recent trends and other needleless drug delivery systems is given. Needle free injection technology is growing and has the potential to make the administration of medicine more efficient, safe and convenient.

 

Type: Commentary
Incorporating a Continuing Professional Development Process into Residency Training
Authors: Tofade Toyin , Scolaro Kelly L. , Bjerke Lina , Crum Meghan , Ferreri Stefanie P.
Published: January 2018

Continuing Professional development (CPD) has been defined as a "self-directed, ongoing, systematic and outcomes-focused approach to learning and professional development." CPD is an important process that can be used to achieve a habit of lifelong learning and competence in the profession. The CPD process includes 5 steps - reflect, plan, act, evaluate and document. It has been postulated that introducing CPD early in a pharmacist's career encourages the development of life-long learning habits. Pharmacy residents are an ideal cohort to implement CPD into their program, since their accrediting body, the American Society of Health System Pharmacists (ASHP) already encourages the use of deliberate goal identification and evaluation throughout the resident's training. We describe here the process of integrating a continuing professional development (CPD) model into a residency teaching certificate program, subsequent lessons learned and recommendations for the future.

 

Type: Idea Paper
Collaborative Drug Therapy Agreement Topics in the State of Washington: From Dispensing Pills to Managing Ills
Authors: Hecox Nancy
Published: January 2018

Type: Commentary
Assessment of a pharmacist-led comprehensive medication management and wellness program
Authors: Janovick Daniel L. , Green Tara R. , Bright David R.
Published: January 2018

Background: Pharmacists are currently providing comprehensive medication management in the outpatient setting. However, there is little documented evidence demonstrating pharmacists are generating further improved health outcomes utilizing non-pharmacologic support, such as fitness and nutrition counseling. The objective of this study is to determine if a pharmacist-led wellness program with medication management and lifestyle modifications through fitness and nutrition coaching can lead to improved biometric markers.

Methods: The wellness program targeted corporate employees and was offered in a corporate headquarters' setting with an on-site workout facility. The program was expected to recruit approximately 15 patients into the wellness program consisting of two treatment arms. The standard group featured nutrition-based classes, medication therapy management and fitness education. The intervention group performed the standard group's activities plus direct, supervised fitness training once weekly. Measured biometric markers were assessed at baseline, 3.5 months, and 7 months and included body mass index (BMI), waist circumference (WC), fasting blood glucose (FBG), systolic and diastolic blood pressure (SBP and DBP), and full lipid panel (TC, TG, HDL, and LDL).

Results: Seventeen patients were enrolled in the study. The standard group (n = 11) and intervention group (n = 6) had relatively similar biometric markers at baseline. Seven total patients completed the study (4 from standard group, 3 from intervention group). The majority of biometric markers improved in both groups, and BP and LDL control was maintained for all who completed the study.

Conclusion: These data suggest that a licensed pharmacist with certified personal trainer credentials may be capable of maintaining biometric markers at healthy levels and improving where necessary in an employee wellness program through one-on-one medication, fitness and nutrition support. Additional, large-scale research is needed to verify the clinical outcomes and feasibility in a larger group setting.

 

Type: Clinical Experience
Providers' perceptions of monitoring process for pregnancy category D or X medication in women of childbearing age
Authors: Lounsbery Jody L. , Leone Barbara , Slattengren Andrew
Published: January 2018

Background and Objectives: A process for monitoring the prescribing of common pregnancy category D or X medications in women of childbearing age (ages 12 to 50) was developed and implemented by clinical pharmacists within a residency clinic. The project goals were to determine 1) if providers value the monitoring of their prescribing practices, 2) if they value the process used by the clinic, and 3) if providers report changing prescribing practices or note increased awareness when prescribing pregnancy category D or X medications in women of childbearing age as a result of the monitoring process.

METHODS: An electronic survey was distributed to the 43 providers currently practicing in the clinic. Survey questions covered topics including value of monitoring prescribing practices for pregnancy category D or X medications in women of childbearing age, value of the specific monitoring process used at the clinic, frequency of consideration of pregnancy status and contraception use when prescribing medication, and suggestions for improvement on the monitoring process.

RESULTS: The response rate was 81.4% (n=35). Results showed all responders valued the monitoring of their prescribing of pregnancy category D or X medications and the monitoring process used by the clinic. Providers reported the monitoring process increased how often they thought about a patient’s pregnancy status and contraception use when prescribing medications.

CONCLUSIONS: The monitoring process is valued by providers and impacts prescribing practices. It is a quality process that could be implemented by clinical pharmacists in other primacy care practices to enhance the safe prescribing of medications for women of childbearing age.

 

Type: Original Research
Reducing Health Care Costs and Improving Clinical Outcomes Using an Improved Asheville Project Model
Authors: Bunting Barry A. , Nayyar Deepika , Lee Christine
Published: January 2018

This study was designed to add to the body of knowledge gained through the original Asheville Project studies, and to address some of the limitations of the earlier studies. Scalability. Since the original Asheville Project publications there have been some successful replications, however, there is a need to broaden the geographic scope and increase the size of the study population. Study Design. Previous studies were limited to pre-post, self-as-control design. We added a control group. Model improvement. We were able to incorporate an electronic record of care. This allows incorporation of medical and prescription claims, ease of documentation, improved data capture, reporting, standardization of care, identification of deficiencies in care, and communication with other health care providers. This enhancement may be worthy of more comment than we devoted to it , however, we didn’t want to detract from the main goal of the study, and we wanted to avoid any hint of commercialization on the part of the organization that provided the electronic record. Relevance to profession. We sincerely hope the relevance goes beyond the profession of pharmacy and that it reinforces the message that the profession of pharmacy offers real solutions to rising health care costs in the U.S.

 

Type: Original Research
Multiple Bosses: Challenges and suggestions to improve organizational environments in academic settings.
Authors: Feemster Agnes Ann , Mattingly T. Joseph
Published: January 2018

Practice faculty members are often supervised by more than one individual, creating a reporting structure that mirrors a matrix organization. They are tasked with balancing administrative and teaching responsibilities established by the school with expectations of maintaining a pharmacy practice site. A matrix reporting structure offers opportunities for enhanced development, but risks of additional stress from the organizational complexity must be mitigated to reduce job dissatisfaction. Frequent and consistent communication, mutual agreement and alignment of expectations and priorities, and the ability to manage conflict and adapt to change will aid pharmacy practice faculty in managing the relationship between their primary employer (the school) and the contracted entity.

Conflict of Interest

We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.

 

Type: Original Research
Imaginary Worlds: Modeled claims for cost-effectiveness published in PharmacoEconomics January 2015 to December 2015
Authors: Langley Paul C
Published: January 2018

The purpose of this review is to assess whether or not economic evaluation studies published in PharmacoEconomics in 2015 meet the standards of normal science. Two questions are key to the assessment: (i) did the authors attempt to generate testable claims as to the impact of the pharmaceutical product in health care systems and (ii) did the authors suggest how the claims might be evaluated? A total of 31 studies were evaluated, including 14 research articles, 8 systematic reviews and 9 reviews. Although the majority of the studies met recommended standards for cost-effectiveness analysis, none met the standards of normal science. They were best categorized as imaginary worlds or thought experiments. The reader has no idea whether the claims for the products are right or even if they were wrong. Journal editors have two options: (i) require authors to submit cost-effectiveness claims that are evaluable with a protocol suggesting how the claim may be evaluated or (ii) continue to publish non-evaluable cost-effectiveness claims but insist authors indicate that the claims are non-evaluable.

Conflict of Interest

None

Type: Commentary
Assessment of Barriers to Providing Introductory Pharmacy Practice Experiences (IPPEs) in the Hospital Setting
Authors: Gibson Matthew J , Sullivan Donald , Tubbs Crystal , Mirtallo Jay , Kelley Katherine
Published: January 2018

Objectives: The primary objective of the study is to identify the barriers to providing Introductory Pharmacy Practice Experiences (IPPEs) in the hospital setting.

Methods: Potential barriers to IPPEs were identified via literature review and interviews with current IPPE preceptors from various institutions. Based on this information, an electronic survey was developed and distributed to IPPE preceptors in order to assess student, preceptor, logistical and college or school of pharmacy related barriers that potentially exist for providing IPPE in the hospital setting.

Results: Sixty-eight of the 287 eligible survey respondents (24%) completed the electronic survey. Seventy-six percent of respondents agreed or strongly agreed that available time was a barrier to precepting IPPE students even though a majority of respondents reported spending a third or more of their day with an IPPE student when on rotation. Seventy-three percent of respondents disagreed or strongly disagreed that all preceptors have consistent performance expectations for students, while just 46% agreed or strongly agreed that they had adequate training to precept IPPEs. Sixty-five percent of respondents agreed that IPPE students have the ability to be a participant in patient care and 70% of preceptors believe that IPPE students should be involved in patient care.

Conclusions: Conducting IPPEs in the institutional setting comes with challenges. Based on the results of this study, experiential directors and colleges/schools of pharmacy could make a positive impact on the quality and consistency of IPPEs by setting student expectations and training preceptors on appropriate and consistent expectations for students.

 

Type: Original Research
Perceptions of Medicinal Plant Use Amongst the Hispanic Population in the St. Louis Metropolitan Area
Authors: Grafford Kim M. , Nieto Marcelo J. , Santanello Catherine D.
Published: January 2018

Introduction: Medicinal plant use in the United States has increased as reported by the National Center of Complementary and Integrative Health and U.S. Census Bureau.However, little is known about how many minority groups in the United States use medicinal plants.There is a rise in the Hispanic population; a community with a steep tradition of medicinal plant use, in the U.S., so understanding the perceptions of medicinal plant use is useful to healthcare providers.

Methods: A survey was designed to gauge a better understanding of the perceptions of medicinal plant use amongst Latino patients with varying education levels who reside in the St. Louis Metropolitan Area. Survey questions highlighted the perceptions of medicinal plants use, patient communication regarding medicinal plant use with healthcare providers (pharmacists and doctors), and the impact the education level has on medicinal plant use.

Results: Surveys were distributed to six different investigational sites around the St. Louis Metropolitan Area from August 2015 to December 2015. Survey respondents identified 45 different plants/herbs that they currently use or had used at some point in their life. Those with higher levels of education had varying opinions on medicinal plant use with their current practices.

Conclusion: The participants’ high interest in the use of medicinal plants exemplifies the need for enhanced communication between patients and healthcare professionals about medicinal plant use. However, it was hard to determine whether the participants’ level of education had any direct relationship to this use.

Conflict of Interest

None

 

Type: Original Research
Pharmacists’ Provision of Contraception: Established and Emerging Roles
Authors: Peters Lindsey M , DiPietro Mager Natalie A
Published: January 2018

Pharmacists’ roles in provision of family planning products is expanding in the United States (U.S.). This article details established as well as emerging roles for U.S. pharmacists in the provision of contraception. These include helping patients develop reproductive life plans; dispensing prescription contraceptive products and counseling patients; assisting and educating patients with non-prescription contraceptive products, including emergency contraception; participating in collaborative practice agreements; administering contraception products; and making referrals and developing partnerships. The provision of contraception in the U.S. is dynamic, and pharmacists should continue to be aware of changes that will impact them professionally. As approximately 45% of pregnancies in the U.S. are unintended, through these roles pharmacists can impact an important public health priority.

Conflict of Interest

We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties

 

Type: Idea Paper
Creative Destruction: Next Generation Sequencing in Drug Development, Formulary Evaluations and Pricing
Authors: Langley Paul C
Published: January 2018

Next generation sequencing (NGS) has the potential to disrupt not only the accepted process of drug development but also the hurdles a drug manufacturer would be expected to face in securing formulary approval and a possible premium price for the new compound. The purpose of this commentary is to consider the role of NGS in this process, one which is characterized as a process of creative destruction, where adoption of NGS in personalized medicine sets in train a mechanism of incessant product and process review. A mechanism driven by continuing modifications and extensions to NGS platforms as our understanding of the role of mutations and mutation load in therapy choice expands. At the same time this mechanism has significant implications for the continued revision of treatment guidelines and their adoption of NGS as integral parts of the treatment pathway. There are, however, a number of unresolved issues which have to be addressed. These include the choice of NGS platform, barriers to integrating evidence to support NGS-based therapy choices in treatment guidelines, the implications of NGS for drug development and the modification or rejection of current trial structures, the integration of comorbid disease states and the standards that formulary committees should adopt to evaluate NGS claims. The overarching theme, however, is the need to invest in a robust and credible evidence base. While we are a long way from achieving this, the focus must be on putting claims for therapy choice forward that are credible, evaluable and replicable.

 

Type: Commentary
Community Pharmacist Attitudes on Medication Synchronization Programs
Authors: Witry Matthew , Hoang Thao
Published: January 2018

Background: Medication synchronization is a service offered by an increasing number of community pharmacies that aligns refilling of a patient’s multiple medications. Purported benefits include increased adherence and improved dispensing efficiency.

Objective: To assess community pharmacist agreement with a set of declarative statements about medication synchronization programs and to identify variation related to pharmacist characteristics.

Methods: In 2015, a cross-sectional survey was mailed to 1,000 pharmacists from 5 Midwestern U.S. states using 4-contacts and an online option. Respondents used a 7-point Likert scale to agree or disagree with 5 statements about medication synchronization. Demographic and workplace characteristics were collected. Data were analyzed using descriptive statistics and factor analysis. Multiple linear regression tested the relationship between pharmacist characteristics and a 4-item attitude composite.

Results: There were 258 usable responses for a response rate of 28.8%. About half (45.0%) reported their pharmacy offered medication synchronization. Most pharmacists (82.6%) agreed this service has a positive impact on patient adherence but 57% agreed that a “significant change to workflow” was or would be required. Pharmacist agreement that the program provides financial benefits to the pharmacy was higher than agreement that the service provides more opportunities for patient interactions (p<0.001). In the multiple regression analysis, having a PharmD and working at a pharmacy offering Medication Therapy Management were associated with more positive scores on the medication synchronization benefits composite whereas working in a staff role (rather than a manager/owner) was lower. No demographic predictors were significantly associated with agreeing that a significant change to workflow would be required for implementation.

Conclusions: Pharmacists generally were positive about medication synchronization programs, although some negative views were present, especially regarding the need for workflow change. Research is needed to understand barriers and facilitators to how medication synchronization programs are implemented and maintained and their effects on outcomes.

Conflict of Interest

We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.

 

Type: Original Research
Pharmacy-Based Tuberculosis Skin Testing (TST): Approaches to Legal Authority
Authors: Atkinson Dylan , Dering-Anderson Allison M. , Adams Alex
Published: January 2018

The Mantoux Tuberculin Skin Test (TST) is the standard method for detecting latent tuberculosis and has been provided by pharmacists since at least 2006. In the largest published study of pharmacy-based TST involving 578 patients, the most common reason for obtaining the test were employment or school requirements.Pharmacists have demonstrated high rates of follow-up for the reading of the test, reported to be 92.8% to 94.4%. The biggest barrier to pharmacy-based TST is that a prescription is required for the two tuberculosis (TB) purified protein derivative products available on the market in the United States. States have adopted three strategies to enable pharmacy-based TST prescribing: 1) collaborative practice agreements; 2) statewide protocols; and 3) independent prescribing. These three approaches are reviewed, with a focus on the New Mexico statewide protocol and the recent statutory authority in Idaho that grants pharmacists independent prescriptive authority for TST. States may consider pursuing more autonomous models of TST prescribing given the safety and track record of this service at pharmacies.

 

Type: Commentary
Development of an Integrated Immunology and Vaccines Pharmacy Elective
Authors: James Stephanie F , Braun LaToya J , Feltman Christine , Haight Robert
Published: January 2018

Objective: To describe an elective course on immunology and vaccines for pharmacy students that extends beyond basic immunization training.

Design: A three credit-hour Immunology and Vaccines elective was developed and taught by an immunologist, policy research expert, and pharmacist. The learning objectives of the course included: understanding how the immune system works with vaccines to provide protection against infectious diseases, the history and policies involved in immunization practice, and how to counsel the vaccine hesitant individual. Classes were conducted using a variety of formats; group projects, lectures, films, literature reviews and guest speakers. An end-of-course evaluation was used to gauge student opinion on course value. Students were evaluated by four exams and a final group presentation.

Conclusion: Students indicated that this course was valuable to their future pharmacy careers and provided insight into why people choose not to vaccinate and how they could use the course insight to properly educate such individuals.

Conflict of Interest

We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties

 

Type: Note
Impact of a Modified Jigsaw Method for Learning an Unfamiliar, Complex Topic
Authors: Kolanczyk Denise , Arif Sally A
Published: January 2018

Objective: The aim of this study was to use the jigsaw method with an unfamiliar, complex topic and to evaluate the effectiveness of the jigsaw teaching method on student learning of assigned material (“jigsaw expert”) versus non-assigned material (“jigsaw learner”).

Innovation: The innovation was implemented in an advanced cardiology elective. Forty students were assigned a pre-reading and one of four valvular heart disorders, a topic not previously taught in the curriculum. A pre-test and post-test evaluated overall student learning. Student performance on pre/post tests as the “jigsaw expert” and “jigsaw learner” was also compared.

Critical Analysis: Overall, the post-test mean score of 85.75% was significantly higher than that of the pre-test score of 56.75% (p<0.05). There was significant improvement in scores regardless of whether the material was assigned (“jigsaw experts” pre=58.8% and post=82.5%; p<0.05) or not assigned (“jigsaw learners” pre= 56.25% and post= 86.56%, p<0.05) for pre-study.

Next Steps: The use of the jigsaw method to teach unfamiliar, complex content helps students to become both teachers and active listeners, which are essential to the skills and professionalism of a health care provider. Further studies are needed to evaluate use of the jigsaw method to teach unfamiliar, complex content on long-term retention and to further examine the effects of expert vs. non-expert roles.

Conflict of Interest

We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.

 

Type: Note
Transparency, Imaginary Worlds and ICER Value Assessments
Authors: Langley Paul C.
Published: January 2018

The Institute for Clinical and Economic Review (ICER) is seen as offering a credible platform for evaluating the pricing policies for pharmaceutical products and devices. Over the past few years ICER has presented a stream of reports, many of which have recommended substantial price discounts where the results of a lifetime cost-per-QALY modeling suggests they are out of line with notional willingness to pay thresholds and arbitrary budget constraints. At the same time, there have been growing concerns over the lack of transparency in the ICER value assessment process, focusing in particular on the refusal by ICER to allow access to its value assessment modeling framework. The purpose of this brief commentary is to point out that the position taken by ICER over model access is not defensible; the arguments given are specious. This ongoing refusal undercuts the ICER claim to be independent and the credibility of ICER recommendations for price discounting. The solution is for ICER to commit to a transparent process of value assessment, allowing in particular access to its models and for the ICER model to be subject to an independent assessment. At the same time, manufacturers and other stakeholders should have access to the model with the opportunity to challenge the model through developing model frameworks which they feel better represent product value. This advocacy, it should be noted, does not reflect acceptance of the ICER lifetime cost-per-QALY value assessment framework. Health care decision makers would be better served by a value assessment framework that provided short-term credible, evaluable and replicable claims, facilitating meaningful feedback to decision makers, and not on the construction of simulated imaginary worlds.

Conflict of Interest: None

 

Type: Commentary