Medication Requests Research Articles

Improving Timely Medication Access for Endocrinology and Diabetes Patients: A Quality Improvement Initiative

ABSTRACT Introduction Managing chronic conditions such as endocrinology and diabetes requires consistent access to medications. Traditional methods of medication refill often involve in-person visits to healthcare providers or pharmacies, posing challenges for patients. Online medication refill services offer a promising solution to improve accessibility and convenience. Methods This is a digital-based solution using online medication refill services to enhance the management of endocrinology and diabetes medication refills. It examines the process of online medication refill, including patient registration, refill request submission, verification, provider input, processing, and pickup or delivery. Results Online medication refill services empower patients to easily request refills from the comfort of their homes, streamlining the refill process, and reducing walk-in pressure in clinics. The online medication refill with the option for home delivery option eliminates the need for patients to visit the hospital, further enhancing the patient experience. Before implementing the online medication refill solution, 26 patients will come to the clinic as walk-ins to request medication refills. The average waiting time for each patient is 45 minutes. Each provider will be interrupted for an average of 10 minutes to accommodate the request. The overall processing time required for each walk-in patient to submit the medication request is 1 hour on average. After implementing the online medication refill intervention, zero patients come to the clinic as walk-ins and hence, no interruption to the daily regular clinics. The overall processing time required for submitting the online medication request is now 2 minutes. These interventions promote medication adherence and patient engagement by facilitating access to medications and offering educational resources. Conclusion Online medication refill services represent a valuable tool in the comprehensive management of endocrinology and diabetes. They offer accessibility, convenience, and patient empowerment, potentially improving health outcomes and enhancing the overall patient experience.

Medicaid-Insured Women’s Perceptions of Obstetric Care Quality: Implications for Reproductive Health Equity in the United States

Racial and socioeconomic disparities in maternal health outcomes are significant in the United States. Expanded access to obstetric care through Medicaid, a public health insurance program, aims to address these disparities among racially and economically marginalized birthing people. However, limited research has examined the experiences of women whose obstetric care was covered by Medicaid. This study utilized a birth equity framework informed by reproductive justice principles to analyze interviews with 30 Medicaid-insured women in South Carolina. The analysis focused on study participants’ perceptions of their obstetric care experiences during their most recent pregnancy and hospital stay for labor and delivery. Thematic analysis revealed that participants felt disrespected, dismissed, and ignored by their obstetric care providers. Problems included insurance-related discrimination, insufficient explanations about treatment protocols, mismanagement of pregnancy complications, disregarded pain medication requests, inadequate monitoring of labor progression, and physician absences during delivery. The results substantiate the need for birth equity–informed interventions that facilitate structural competency and cultural humility among medical professionals to improve obstetric care quality among marginalized patients.

Payor denial after prior authorization request for long-acting pain medication: Provider and patient perspectives.

11004 Background: For patients with cancer, uncontrolled pain can reduce quality of life, lead to treatment breaks, and result in worse cancer outcomes. Guideline-concordant treatment for chronic, severe pain can include long-acting opioid formulations. Pain medications, however, often face prior authorization (PA), which requires providers to obtain payor pre-approval and may result in delayed or denied care. This analysis characterizes PA-related denials for pain medications for patients with cancer. Methods: At an urban comprehensive cancer center, we identified all PA requests for outpatient long-acting opioid (i.e., buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol) prescriptions from 2023 and described frequency of PA approvals and denials. For denials, chart review 2 weeks post-PA was conducted of provider notes and patient communications with results summarized qualitatively. Results: 1752 new long-acting opioids prescriptions for 982 unique patients required PA. Of those, 1567 (89.4%) were approved after PA process, 99 (5.6%) were denied, 81 (4.6%) were cancelled after PA initiation, and 6 (0.3%) were unresolved. Most were prescribed by pain specialists including supportive care (n = 699, 40.0%) and anesthesia/pain medicine (n = 444, 25.3%) with most common indication: “Neoplasm related pain (chronic)” (61.1%). Oxycodone was the most common long-acting opioid requiring PA (n = 551, 31.4% of prescriptions), followed by fentanyl (n = 501, 28.6%), hydromorphone (n = 205, 11.7%), and methadone (n = 137, 7.8%). Long-acting morphine was denied most frequently (16.3% of n = 129 PA requests denied), followed by buprenorphine (12.1% of n = 33), and hydromorphone (7.3%). Fentanyl was denied the least (2.8%). The 99 denials affected 62 unique patients, including a patient with 7 denials. Chart review (n = 62) of the 2 weeks post-denial revealed a median of 2 (range 0-8) provider notes mentioning pain or PA barriers and median of 1 (range 0-5) patient calls or messages about the same. 22.6% (n = 14) patients ended up in the ER or admitted to the hospital for pain crisis or failure to thrive. Providers documented poor pain control, weight loss, need to “try and fail” other medications, and noted 11.3% (n = 7) patients ending up paying out of pocket for their medications. Patient messages document uncontrolled pain and unmanageable side effects with some literally begging for relief; one patient spoke of their fear of “dying in pain”. Conclusions: The vast majority of PA requests for long-acting pain medication result in approvals, suggesting that the process -which can delay essential pain management- is largely unnecessary. For the 1 in 20 requests that were denied, provider and patient concerns highlight the negative impact of uncontrolled pain. An improved, transparent PA process is essential for adequately treating chronic, cancer-related pain.

A mixed methods evaluation of the appropriateness of hospital on-call pharmacy service use

Abstract Introduction Most English hospitals provide out-of-hours pharmacy support via an ‘on-call pharmacist’.[1] There is scant published literature characterising these services. Prior research[2] suggests a significant number of calls may be inappropriate requests for non-urgent medication or information readily available elsewhere. Delaying while the on-call pharmacist is unnecessarily contacted may avoidably compromise patient care. Handling inappropriate calls may decrease pharmacist job satisfaction and compromise rest between shifts. Dissatisfaction with the on-call commitment is regularly raised at local departmental meetings and exit interviews. Servicing such calls is not sustainable. Aim To explore and quantify appropriateness of calls to the on-call pharmacy service at a single, large, acute English hospital, and to explore the influencing factors behind any inappropriate calls using a theoretically informed approach. Methods A retrospective review of existing on-call records quantified and characterised service use in 2021. Missed calls, callers who did not want the on-call pharmacist and internal pharmacy handovers were excluded. As per previous work, calls were considered inappropriate where an available resource would have provided a complete solution/answer at the caller’s level.[2] Service users were invited to semi-structured interviews via email to explore their capability, opportunity, and motivation to handle pharmaceutical issues. Interviews were conducted and recorded on Microsoft Teams before being transcribed and analysed using a framework based on the COM-B model of behaviour. Quantitative data were analysed in Excel and SPSS v27. Pearson’s chi-square test of independence was calculated for several pre-defined variables with p<0.05 considered significant Results There were 1139 calls in 2021, with 32 meeting exclusion criteria. Of the 1107 remaining, 410 (37%) were inappropriate and 697 (63%) appropriate. Eighty-one (20%) inappropriate calls occurred overnight (22:00-08:30). Almost 90 hours were spent on inappropriate calls, generating £3,144.96 in additional overtime payments to pharmacists. Appropriateness was found to be significantly higher on weekdays (66%) versus weekends (58%), p=0.008, from surgical wards (67%) versus medical wards (58%), p = 0.042 and from doctors (74%) versus nurses (54%), p<0.001. All respondents (five doctors) were interviewed. Analysis found limited training and familiarisation led to low awareness of available resources. Access was often restricted by a cumbersome Trust intranet rather than lack of time. Participants were highly motivated to resolve issues themselves, believing this to be best practice. Conclusion The high proportion, high volume and high cost of inappropriate calls warrants further investigation and intervention. Unfortunately, no nurses responded to interview invitations; this is a significant limitation as nurses were more likely to place inappropriate calls. Future work should consider how nurses can be recruited more effectively. However, analysis of calls combined with elucidation of doctors’ behavioural determinants makes it possible to propose informed interventions. Doctors would benefit from improved awareness of/ability to use resources and improved access to them. Therefore, a searchable electronic “signpost” highlighting resources relevant to common on-call queries is proposed. This would leverage the doctors’ high motivation and the rich data collected in a sustainable, evidence-based intervention designed around service user needs.

Implementing Distribution Requirement Planning in Medan City Health Department's Medicine Distribution System

One of the pharmacy installations located in the Medan city area was tasked with overseeing the management of pharmaceutical inventory for public health facilities, ensuring adequate stock levels, and processing medication-related data, including receiving supplies and LPLPO forms from 41 Public Health Centers. Supervisors at the pharmacy installation were responsible for dispensing medications, while medication managers at the Public Health Centers handled medication requests by completing LPLPO forms and sending them to the installation. Issues arose regarding the accuracy of medication data within its operations, encompassing aspects such as initial stock, receipt of medications, inventory management, medication disbursement (including usage, damaged, or expired items), remaining stock, medication requests, and discrepancies between reported and actual medication quantities. The objective of this study was to establish a web-based data processing system utilizing the Distribution Requirement Planning (DRP) methodology. The DRP approach offered significant insights for forecasting medication stock demands and effectively guided the pharmacy installation in meeting the medication needs of the Public Health Centers. Furthermore, the DRP method shed light on the distribution process costs, thus serving as a valuable tool for enhancing cost efficiency and effectiveness. Results obtained through the DRP approach provided a more efficient distribution process, yielding a notable 93% reduction in expenditure. Additionally, the DRP method successfully anticipated future requirements by employing structured calculations that delineated demand levels experienced by each Public Health Center, accounting for the distinct needs of each facility.

A cohort study comparing pharmacist activities during participation in general medical ward rounds: telehealth versus in-person during the COVID-19 pandemic.

The COVID-19 pandemic created systemic challenges in patient care delivery. To evaluate the impact on pharmacist activities during pharmacist participation in ward rounds via telehealth, compared to physical attendance. A single-centre, retrospective cohort study conducted from 18th Aug through 26th Oct 2020. Patients admitted to COVID and non-COVID general medical teams were included. Pharmacists attended ward rounds via telehealth for COVID teams; physical attendance continued for non-COVID teams. Telehealth involved pharmacists interacting with clinicians and patients virtually via videoconferencing whilst stationed remotely on the ward. Routine clinical pharmacy activities during telehealth ward rounds were compared to those during face-to-face ward rounds using comparative statistics. Among the 1230 patients included (762 COVID, 468 non-COVID), pharmacist participation in telehealth ward rounds demonstrated significantly more documented activities compared with face-to-face rounds (mean 6.7 vs 4.9 per patient per day, p < 0.001). The telehealth cohort exhibited a higher number of orders placed via pharmacy-partnered medication charting (3.0 vs 2.4 per patient per day, p < 0.001), medication orders verified (2.3 vs 1.1, p < 0.001), and documented pharmacy notes (0.6 vs 0.2, p < 0.001). No significant difference was observed in medication requests processed (0.4 vs 0.4, p = 738), whilst non-COVID patients had more discharge prescription items generated (0.3 vs 0.7, p < 0.001). Pharmacist involvement in medical ward rounds via telehealth enabled the ongoing provision of advanced clinical pharmacy services to inpatients in isolation rooms during the COVID-19 pandemic. This approach resulted in a greater number of pharmacy activities during telehealth ward rounds compared to standard in-person attendance.

Depressive Symptoms and Missed Nursing Care among Clinical Nurses: A Cross-Sectional Survey

Purpose: This study aimed to compare missed nursing care between nurses with and without depressive symptoms. Methods: A cross-sectional survey was conducted with shift-working nurses at a general hospital in South Korea. Data from 184 nurses were analyzed using the independent t-test, the &lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; test and the Fisher’s exact test. Results: The most frequently missed nursing care items reported by hospital nurses were, in descending order, monitoring intake/output, assessing the effectiveness of medications, bathing and skin care, washing hands. The order of missed nursing care items was similar between groups with and without depressive symptoms, but there were statistically significant differences between the two groups in the mean scores for vital signs, bedside glucose monitoring, turning patients every 2 hours, providing emotional support to patients, skin/wound care, patient discharge planning, response to the call light, and pro re nata (PRN) medication requests acted on. Conclusion: Nurses’ mental health needs to be monitored and managed more closely, as it is correlated to missed nursing care. Health institutions and nursing departments should support nurses through strategies that can quickly detect and manage nurses’ depressive symptoms. Systematic resources incorporating social support among nurse colleagues could also be used as strategies to reduce depressive symptoms and missed nursing care.

Pharmacovigilance in the Caribbean Countries: an Overview.

The constant surge in accessing essential medicines creates a greater need for continuous monitoring of usage. The inability to source active pharmaceutical ingredients during the COVID-19 pandemic resulted in drug shortages that increased online requests for medications. E-commerce and social sites have opened the floodgate for the marketing of falsified, substandard, and unregistered pharmaceuticals, making them easily accessible to consumers with the click of a button. A high prevalence of such products with compromised quality highlights further the need for enhanced post-marketing vigilance of safety and quality within the pharmaceutical industry. This review aims to assess the extent to which pharmacovigilance (PV) systems in selected Caribbean countries conform to the minimum World Health Organization (WHO) requirements, highlight the importance of PV in ensuring the safer use of medicines across the Caribbean region, and identify opportunities and challenges in building comprehensive PV systems. The review finds that while major advancements in PV and adverse drug reaction (ADR) monitoring have occurred in Europe and other parts of the Americas, little has been done in the Caribbean region. Only a few countries in the region are active members of the WHO's global PV network, and ADR reporting is minimal. The reason for low reporting includes a lack of awareness, commitment, and participation of healthcare professionals, manufacturers, authorized distributors, and the general consumers. Nearly all established national PV systems do not fully conform to the minimum PV requirements by the WHO. Legislation, regulatory framework, political commitment, adequate funding, strategies, and incentives to encourage reporting of ADRs are needed to build sustainable PV systems in the Caribbean.

Differences between Registered Nurses and nurse assistants around missed nursing care-An observational, comparative study.

From a nursing perspective, tasks that are not carried out, and the consequences of this, have been studied for over a decade. The difference between Registered Nurses (RNs) and nurse assistants (NAs) regarding qualifications and work tasks, and the profound knowledge around RN-to-patient ratios, warrants investigating missed nursing care (MNC) for each group rather than as one (nursing staff). To describe and compare RNs and NAs ratings of and reasons for MNC at in-hospital wards. A cross-sectional study with a comparative approach. RNs and NAs at in-hospital medical and surgical wards for adults were invited to answer the MISSCARE Survey-Swedish version, including questions on patient safety and quality of care. A total of 205 RNs and 219 NAs answered the questionnaire. Quality of care and patient safety was rated as good by both RNs and NAs. Compared to NAs, RNs reported more MNC, for example, in the item 'Turning patient every 2 h' (p < 0.001), 'Ambulation three times per day or as ordered' (p = 0.018), and 'Mouth care' (p < 0.001). NAs reported more MNC in the items 'Medications administered within 30 min before or after scheduled time' (p = 0.005), and 'Patient medication requests acted on within 15 min' (p < 0.001). No significant differences were found between the samples concerning reasons for MNC. This study demonstrated that RNs' and NAs' ratings of MNC to a large extent differed between the groups. RNs and NAs should be viewed as separate groups based on their different knowledge levels and roles when caring for patients. Thus, viewing all nursing staff as a homogenous group in MNC research may mask important differences between the groups. These differences are important to address when taking actions to reduce MNC in the clinical setting.

Development and implementation of a telephone triage curriculum for neurology residents (P3-2.005)

<h3>Objective:</h3> Build a curriculum to support and improve neurology resident’s telephone triage skills of a patient emergency response line. <h3>Background:</h3> Many neurology trainees answer patient questions over the telephone while on call with minimal training or experience. Other non-neurology residencies have published quality improvement studies on trainee specific training on telephone triage skills. Not all institutions have imbedded training for residents on telephone triage skills. <h3>Design/Methods:</h3> Two months of pages routed through the pager response line were collected at an academic institution. A list of neurological complaints was created based upon the text of the page. Residents completed a pre-intervention survey of confidence level for management telephone triage. Based upon aggregated data of common neurologic complaints, a 1-hour lecture was given and triage flowsheets were developed to train residents on appropriate over-the-phone management of common neurological complaints. A post-intervention self-evaluation survey is planned for one month after the flowsheets are distributed to the residents. <h3>Results:</h3> The most common neurological complaints from patients using the pager response line were breakthrough seizure, persistent or worsening headache, a new neurological symptom, or worsening functional decline (46% of pages). Other common indications for calls included concern for a medication side effect or request for medication refills (35% of pages). For the pre-intervention survey, the majority of the residents (80%) responded as “not at all confident” to “somewhat confident” in their response to “How confident are you with answering pager response line pages independently?”. <h3>Conclusions:</h3> Majority of residents were not confident in providing the telephone triage service for our departmental after-hours pager response line. This exemplifies the need for more specific neurological telephone triage training for residents providing this service. A curriculum has been developed and is currently being implemented based upon the most common neurological complaints found during our study period. Post training survey will be administered November 2022. <b>Disclosure:</b> Dr. Eckenstein has nothing to disclose. Dr. Wold has nothing to disclose.

Patient characteristics and factors contributing to recurrence of bacterial vaginosis presented in primary care.

Bacterial vaginosis (BV) is a common problem in primary care. BV symptoms often have a negative impact on patients' quality of life and may predispose to gynaecological problems. Some patients experience recurring episodes of BV. This study's objective is to identify possible factors that may be associated with BV recurrence and describe the characteristics of these patients and interventions performed by general practitioners. In this retrospective cohort study, we used data from a primary care registration network in the Netherlands in the period 2015-2020. We analysed differences between patients with recurrent BV and patients with a single episode of BV in terms of characteristics and interventions performed by general practitioners. We found that patients with recently prescribed antibiotics, and a medical history of sexually transmitted infections and/or Candidiasis significantly more often presented with recurrent BV. Patients with recurrent BV had more remote consultations and less in-person consultations than single-episode patients. The reason for encounter was more often a request for medication. Regarding GPs' diagnostic and therapeutic interventions, microbiological tests were more frequently performed in recurrent BV patients. Moreover, most patients in both groups were prescribed oral metronidazole most frequently. Our findings might help GPs to better recognise patients at risk of recurrence. GPs could re-evaluate their approach to the diagnosis and treatment of recurrent BV, opting for in-person consultation and using standardised diagnostic criteria and microbiological testing in patients with recurrent complaints. Antibiotic use for other conditions in these patients may lead to new BV episodes.

Factors Affecting Physicians' Responses to Patient Demands, Stress Perceptions and Coping Styles

Physicians are trying to cope with patients’ potentially inappropriate demands in addition to their intensive work environments. The objectives of this study were to determine physicians’ points of view regarding patient demands, such as requests for inappropriate medical tests, prescription medications, or disability, and to what extent these demands affect physicians. This survey study was completed by conducting face-to-face interviews with the physicians, to determine the knowledge, attitudes, and behaviors of the 196 physicians working in our institution toward patient demands. Physicians reported that disability-related requests were the most prevalent patient demand (71.4%; n=140). A total of 2.6% (n=5) of the physicians performed laboratory tests that they considered unsuitable, 4.1% (n=8) described inappropriate prescription medication requests, and 2.6% (n=5) reported receiving disability requests from patients that they considered to be inappropriate. It was found that knowing patients formerly or being their health workers significantly altered physician behavior and increased rates of meeting inappropriate demand (strong correlation; r=0.809, p&lt;0.001). The average score of the physicians showing their knowledge of the non-compliance of the patient requests was 60.99±10.46 (min-max 30-87.5 points), while the average score of the physicians' attitudes towards the demands they considered inappropriate was 44.73±10.23 (min-max 15-72.5 points). Knowledge and attitude scores were statistically higher in those working time under 10 years, as knowledge scores were statistically higher in those working in the internal medicine branches. In terms of behavior scores, there was no significant difference between working times and branches. In our study, the personality type of the physician was not significant in terms of meeting the patient demand. The job satisfaction of the physicians had no effect on the physician's informed, attitude, and behavior. In terms of stress coping style, the lack of difference in the sub-size of the scale of the subjugation approach was considered to be remarkable. As a consequence, acting for the benefit of the patient in clinical decision making is necessary. It is important to remember that any unnecessary examinations, prescribed medications, or disability requests lead to additional costs, loss of labor, and added workload in addition to posing a health risk for the patient.

Acute Chest Syndrome.

Acute Chest Syndrome.

Outpatient pharmaceutical office: access to medicines in public health

We evaluated the implementation of the outpatient pharmaceutical office in a teaching hospital regarding the access to medicines available in the Unified Health System - SUS. This is a descriptive-analytical study, based on secondary data analysis of 735 appointments performed by the pharmacist from 2015 to 2017. Of the drugs prescribed to patients attended at the outpatient pharmacist office, 86.39% were listed in the National List of Essential Medicines - RENAME, of which 95.43% belonged to the Specialized Component of Pharmaceutical Assistance. Evaluating the patient’s diagnosis against the inclusion criteria of the Clinical Protocols and Therapeutic Guidelines (PCDT), that the most frequent pharmaceutical interventions were: adequacy of the medication request documents (56.4%) and examination requests for pharmacotherapeutic follow up (28.5%). When the prescribed drugs were not included in RENAME/PCDT, the intervention was accepted in 90.3% of the proposals for exchange with available drug in SUS. Still, it was possible to refer the patient to primary care for renewal of continuity of treatment in 95.1% of cases. In conclusion, the role of the clinical pharmacist contributes to the resolution of untreated health problems by promoting access to medicines within the scope of SUS and their rational use in accordance with the PCDT.

Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study

BackgroundOrthopaedic surgeries are among the most painful procedures. By adding low-dose morphine to intrathecal bupivacaine for spinal anaesthesia, the analgesic effect can be improved. The objeсtive of the study was tо compare the efficacy and safety of lоw-dоse (0.1 mg аnd 0.2 mg) intrаtheсаl mоrphine (ITM).MethodsА prоspeсtive rаndоmised study was соnduсted at the Hоspitаl оf Trаumаtоlоgy аnd Оrthоpaediсs, Riga, Latvia (February 2020 tо May 2021) and enrolled 90 patients undergoing primary hip arthroplasty. All subjects were randomised intо three study grоups, using the online tool оn www.randomiser.org. Treatment groups were allocated to intrathecal morphine (0.1 mg and 0.2 mg) in addition to bupivacaine (15 to 18 mg). The primary outcome was postoperative pain intensity among the three study groups within 24 hours by NRS. The secondary outcomes: pain at rest 4 h, 7 h, 12 h, 24 h postoperatively, respiratory rate, SpО2, morphine соnsumptiоn, оxygen supply, opioid-related аdverse reасtiоns within 24 hours postoperatively. Dаtа were аnаlysed using R version 4.2.0, applying the Mann-Whitney test, Pearson’s chi-squared test, Fisher’s exact test, Friedman test, Wilcoxon test.ResultsThe primary outcome in the control, ITM 0.1 mg, ITM 0.2 mg groups, respectively: 2.56, 0.87, 0.28 (p < 0.001). The secondary outcomes in the control, ITM 0.1 mg, ITM 0.2 mg group, respectively: pain scores 4h – 1.21, 0.48, 0.17 (p = 0.068); 7 h – 2.62, 1.00, 0.17 (p < 0.001); 12 h – 3.08, 0.65, 0.37 (p < 0.001); 24 h – 2.50, 1.20, 0.41 (p < 0.001); rescue medication requests (incidence, %): 77%, 16.7%, 13.3% (p < 0.001); mean respiratory rate (breath/min) – 15.2; 15.2 (p > 0.05); mean SpO2 (%): 96.7%; 95.7%; 96.07%. Significant adverse effects: pruritus in ITM 0.2 mg group (23% of subjects, p < 0.001).ConclusionsAdult patients undergoing THA under spinal anaesthesia with bupivacaine and 0.2 mg morphine had superior analgesia to patients who received spinal analgesia with bupivacaine or bupivacaine and 0.1 mg morphine.Trial registrationStudy ID ISRCTN37212222; 20/04/2022 (registered retrospectively)

P002Abortion pills for future use: Who is receiving advanced provision of medications to induce abortion?

<h3>Objectives</h3> To describe sociodemographic characteristics of patients requesting abortion medications for future use from an online provider. <h3>Methods</h3> This descriptive study of requests for advanced provision of mifepristone and misoprostol from Aid Access between August and December 2021 used patient records from nine primary care providers to describe demographics, social vulnerability, and reasons for requesting advanced provision of medications. We used zip code to determine county-level four-point CDC Social Vulnerability Index. <h3>Results</h3> Among 160 people included in the study, requests for medications came from people living in 17 US states, the District of Columbia, and active-duty military. Nearly one-quarter came from California (24%); 16% came from New York, and less than 10% came from each of the remaining locations. The median age was 29 (IQR, 23–35; range 16–47 years). Most patients were childless (84%), and nearly half had either high or medium-high social vulnerability (23% and 26%, respectively). The most common reasons for requesting medications for future use included: personal choice (70%), future legal restrictions (55%), being comfortable at home (47%), privacy (46%), desire to take care of their own treatment (43%), and empowerment (42%). Some other common reasons included stigma (25%), cost (26%), work or school commitments (23%), and desire to keep it a secret (20%). <h3>Conclusions</h3> Patients are requesting abortion medications in advance of confirmed pregnancy for a variety of reasons, even in states with fewer restrictive abortion laws. These results suggest that further research is needed to explore their actual use by these patients.

The outcomes of a national clinical review process for nonformulary medication requests in Saudi Arabia

AbstractBackgroundMedications often constitute a significant percentage of health care budgets; therefore ensuring rational medication use is essential. In December 2017, the Saudi Ministry of Health (MOH) introduced a national clinical review process for nonformulary medications (NFMs) requests across 284 MOH institutions to standardize review and approval process under the governance of Pharmacy and Therapeutics Committee (PTC).ObjectivesThis study aims to describe the effectiveness of implementing a national clinical review process for NFMs on the approval rate, decision turnaround time, and potential cost savings within MOH institutions.MethodsThis was a retrospective, observational cohort study undertaken over 36 months. All NFM requests were received through an electronic system, linking all the ministry's regions and departments with a single coding system. Quantitative descriptive statistics: frequency, percentage, median, and interquartile range were used to present the results of this study. A P value ≤.05 was considered statistically significant.ResultsThe approval rate among a total of 2388 NFM requests was 1733 (74%). The median submission turnaround time for NFM requests in 2018 to 2020 were 12.5 (interquartile range [IQR]: 5‐24), 7 (IQR: 3‐15), and 7 (IQR: 4‐14) working days, respectively (P ≤ .001). The median decision turnaround time for NFM requests in 2018 to 2020 were 7 (IQR: 4‐10), 5 (IQR: 3‐9), and 5 (IQR: 4‐8) working days, respectively (P = .019). Of the 615 disapproved requests, 514 (83.6%) were disapproved for a single reason. Moreover, disapproval of requests equated to a potential cost savings which exceeded 14.8 million United States dollars.ConclusionsThis initial study showed that implementing a structured, systematic review process for NFM requests resulted in potential cost savings and acceptable turnaround times for nonurgent requests. However, further studies are needed to examine the actual cost savings and clinical impact on patient outcomes.

Implementation of a high-impact medication therapy subcommittee within a large academic medical center.

Healthcare systems are challenged with implementing high-cost, high-impact medication therapies with increasing frequency. Pharmacy & therapeutics (P&T) committees may struggle to integrate requests for these medications into their existing formulary review process. This article describes one large academic medical center's experience with creating a new P&T subcommittee that addresses the clinical, operational, and financial challenges these medications present. The High-Impact Medication Therapy Subcommittee was established to optimize the institution's process for reviewing formulary requests for medications that are defined as "high impact"-nononcology medications that are extremely expensive and/or have complex operational or clinical challenges. The multidisciplinary subcommittee has 3 chairs-a physician, a nurse, and a pharmacist-and includes representation from all areas of pharmacy practice (clinical pharmacy, operations, supply chain, finance, and informatics), as well as medical and nursing leadership, hospital finance, and patient access services. Additional relevant stakeholders are invited as needed. The first medication to be reviewed at this subcommittee was afamelanotide, a melanocortin receptor agonist indicated for treatment of erythropoietic protoporphyria. The subcommittee addressed cost-efficacy concerns and operational challenges, and the final recommendation was for formulary addition, with clearly defined restriction criteria and the creation of a new workflow to meet the unique operational considerations with this drug. As medication costs continue to rise at unprecedented rates and reimbursement requirements continue to increase in complexity, the High-Impact Medication Therapy Subcommittee provides a necessary venue for reviewing high-cost medications with complex clinical or operational considerations and proactively addressing implementation challenges.

Acceptability and Efficacy of the SMARxT Media Literacy Education Program to Counter Pharmaceutical Marketing Influences among Medical Trainees.

Evidence-based prescribing (EBP) results in decreased morbidity and reduces medical costs. However, pharmaceutical marketing influences medication requests and prescribing habits, which can detract from EBP. Media literacy, which teaches critical thinking, is a promising approach for buffering marketing influences and encouraging EBP. The authors developed the "SMARxT" media literacy education program around marketing influences on EBP decision-making. The program consisted of six videos and knowledge assessments that were delivered as an online educational intervention through the Qualtrics platform. In 2017, we assessed program feasibility, acceptability, and efficacy of enhancing knowledge among resident physicians at the University of Pittsburgh. Resident physicians (n=73) responded to pre-test items assessing prior knowledge, viewed six SMARxT videos, and responded to post-test items. A 6-month follow-up test was completed to quantitatively assess sustained changes in knowledge and to qualitatively assess summative feedback about the program (n=54). Test scores were assessed from pre- to post-test and from pre-test to follow-up using paired-sample t-tests. Qualitative results were synthesized through content analysis. Proportion of correct knowledge responses increased from pre-test to immediate post-test (31% to 64%, P<0.001) at baseline. Correct responses also increased from pre-test to 6-month follow-up (31% to 43%, P<0.001). Feasibility was demonstrated by 95% of enrolled participants completing all baseline procedures and 70% completing 6-month follow-up. Quantitative measures of acceptability yielded positive scores and qualitative responses indicated participants' increased confidence in understanding and countering marketing influences due to the intervention. However, participants stated they would prefer shorter videos, feedback about test scores, and additional resources to reinforce learning objectives. The SMARxT media literacy program was efficacious and acceptable to resident physicians. Participant suggestions could be incorporated into a subsequent version of SMARxT and inform similar clinical education programs. Future research should assess program impact on real-world prescribing practices.

Discharge Opioids are Unnecessary Following Radical Cystectomy

OBJECTIVETo show that zero-opioid discharges after both open and robotic cystectomy are feasible and to examine the impact of zero-opioid discharges on patient interaction with the physician's office. MATERIALS AND METHODSOne hundred seven patients who underwent either open or robotic radical cystectomy from March 1, 2020 to December 30, 2020 were identified. Patient demographics, perioperative data, and 30 day pain related outcomes including phone calls, office visits, requests for pain medication, emergency department visits, and readmissions were abstracted from the chart. We then examined variables associated with a zero-opioid discharge. RESULTSThirty-two patients were discharged with an opioid prescription (Median Oral Morphine Equivalents Prescribed = 90) and 75 were discharged without an opioid prescription. On regression analysis, age (OR 1.07, 95% CI [1.02-1.12]) and pathology (OR 0.36, 95% CI[0.14-0.9]) remained significantly associated with post-operative opioid prescriptions. There were no differences in the percent of patients presenting to the emergency department, being readmitted, calling the office, calling the office regarding pain, or requesting opioid prescriptions within 30 days of discharge, or the number of post-operative office visits (P >.05 for all). CONCLUSIONPatients can safely be discharged home without opioids following cystectomy, regardless of robotic or open approach. Age and pathology are predictors of the need for an opioid prescription on discharge. These patients did not have increased follow-up visits, phone calls, or requests for pain medication.