Pharmacy Administration Research Articles

Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost.

BackgroundAn estimated 30.3 million Americans have diabetes mellitus. The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to improve the quality of life for people who either have or are at risk for diabetes mellitus, and hence, lower the personal and national economic burden of this debilitating chronic disease. Diabetes self-management education interventions are a primary focus of this initiative.ObjectiveThe aim of this study was to evaluate the impact of the Better Choices Better Health Diabetes (BCBH-D) self-management program on comorbid illness related to diabetes mellitus, health care utilization, and cost.MethodsA propensity score matched two-group, pre-post design was used for this study. Retrospective administrative medical and pharmacy claims data from the HealthCore Integrated Research Environment were used for outcome variables. The intervention cohort included diabetes mellitus patients who were recruited to a diabetes self-management program. Control cohort subjects were identified from the HealthCore Integrated Research Environment by at least two diabetes-associated claims (International Classification of Diseases-Ninth Revision, ICD-9 250.xx) within 2 years before the program launch date (October 1, 2011-September 30, 2013) but did not participate in BCBH-D. Controls were matched to cases in a 3:1 propensity score match. Outcome measures included pre- and postintervention all-cause and diabetes-related utilization and costs. Cost outcomes are reported as least squares means. Repeated measures analyses (generalized estimating equation approach) were conducted for utilization, comorbid conditions, and costs.ResultsThe program participants who were identified in HealthCore Integrated Research Environment claims (N=558) were matched to a control cohort of 1669 patients. Following the intervention, the self-management cohort experienced significant reductions for diabetes mellitus–associated comorbid conditions, with the postintervention disease burden being significantly lower (mean 1.6 [SD 1.6]) compared with the control cohort (mean 2.1 [SD 1.7]; P=.001). Postintervention all-cause utilization was decreased in the intervention cohort compared with controls with −40/1000 emergency department visits vs +70/1000; P=.004 and −5780 outpatient visits per 1000 vs −290/1000; P=.001. Unadjusted total all-cause medical cost was decreased by US $2207 in the intervention cohort compared with a US $338 decrease in the controls; P=.001. After adjustment for other variables through structural equation analysis, the direct effect of the BCBH-D was –US $815 (P=.049).ConclusionsPatients in the BCBH-D program experienced reduced all-cause health care utilization and costs. Direct cost savings were US $815. Although encouraging, given the complexity of the patient population, further study is needed to cross-validate the results.

Identifying opportunities to advance practice at a large academic medical center using the ASHP Ambulatory Care Self-Assessment Tool.

The use of the ASHP Ambulatory Care Self-Assessment Tool to advance pharmacy practice at 8 ambulatory care clinics of a large academic medical center is described. The ASHP Ambulatory Care Self-Assessment Tool was developed to help ambulatory care pharmacists assess how their current practices align with the ASHP Practice Advancement Initiative. The Henry Ford Hospital Ambulatory Care Advisory Group (ACAG) opted to use the "Practitioner Track" sections of the tool to assess pharmacy practices within each of 8 ambulatory care clinics individually. The responses to self-assessment items were then compiled and discussed by ACAG members. The group identified best practices and ways to implement action items to advance ambulatory care practice throughout the institution. Three recommended action items were common to most clinics: (1) identify and evaluate solutions to deliver financially viable services, (2) develop technology to improve patient care, and (3) optimize the role of pharmacy technicians and support personnel. The ACAG leadership met with pharmacy administrators to discuss how action items that were both feasible and deemed likely to have a medium-to-high impact aligned with departmental goals and used this information to develop an ambulatory care strategic plan. This process informed and enabled initiatives to advance ambulatory care pharmacy practice within the system. The ASHP Ambulatory Care Self-Assessment Tool was useful in identifying opportunities for practice advancement in a large academic medical center.

One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program.

Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P < 0.001). There was no difference in MS relapse rate (0.25 after vs. 0.45 before, P = 0.11) or mEDSS score (3.77 after vs. 3.76 before, P = 0.19). Health care resource utilization was minimal and did not change significantly throughout the study period: mean outpatient visits (13.09 after vs. 13.78 before, P = 0.69); mean ED visits (0.18 after vs. 0.16 before, P = 0.60); and mean hospitalizations (0.12 after vs. 0.12 before, P = 1.00). This nonsignificant finding remained when the analysis was limited to MS-related visits only. Average annual health plan spend per patient on MS medications significantly increased ($55,835 after vs. $40,883 before, P < 0.001). Specialty pharmacy and chronic disease management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.

National Survey of Pharmacy Leadership at Ministry of Health in Saudi Arabia: Practice Management

<p style="text-align: justify;"><strong>Objective:</strong> To explore the national survey of pharmacy leadership at the Ministry of Health with emphasis on pharmacy practice. <strong>Methods:</strong> It is a ninety days cross-sectional national survey of pharmacy leadership practice at MOH hospitals. The survey modified from self-assessment of 360 leadership and with pharmacy leadership literature. It consisted of a demographic section, leadership pathway, and fifty-three leadership questions. It contained selected eighteen leadership skills of 360 leadership self-assessment.The leadership skills included Achievement, Goals, Flexibility, Feedback, Excellence, Empowering Others, Emotional Intelligence, Decision Making, Developing Others, Cultural Awareness, Continual Improvement, Communication Skills, Coworker Development, Leading the Change Needed, Attitude, Analytical, Administrative Skill, and Action. This survey distributed to all leadership at MOH hospital pharmacies in Kingdom of Saudi Arabia. All analysis is done through the survey monkey system. The survey divided into for several parts for analysis, and discussion. Part one: practice management, part two: planning and organizations, part three: communications strategies, part four: problem-solving and decision making, part five: performances management, part six; working environment, and part seven: professional development. The study explored the part number one; National Survey of Pharmacy leadership: practice management. <strong>Results:</strong> The survey distributed to one hundred hospitals, the response rate, was forty-two hospitals (42%) with seventy-pharmacy leaders. The gender distribution of responders was Male 43 (63.24%) and female 25 (36.76%) while the nationality was Saudi 69 (98.57%) and non-Saudi 1 (1.43%). The average score Aspects before handling the position was 2.45 (49%) with the highest score was received pharmacy administration orientation 2.57 (51.4%), and the lowest score was received pharmacy administration training courses before handling the positions 2.29 (45.8%). The most sources of gaining skills in pharmacy leadership were life experiences 51 (72.86%) and on job training 29 (41.43%). The average score of administration skills that had pharmacy leaders was 3.63 (72.6%) with the highest score of Communication skills 4.15 (83%), and the lowest score of administration skills was Marketing skills 2.62 (52.4%). Most of the pharmacy leaders had is no incremental of the salary of current positions 44 (67.69%), and most of them got 1-5% only if existed. The majority of pharmacy leaders 29 (43.28%) planned to quit the current position.<strong> Conclusion:</strong> The pharmacy leadership had low satisfaction at a healthcare organization in Saudi Arabia. Targeting of established very comprehensive leadership program with an emphasis on pharmacy leadership is a requirement for Ministry of Health institutions leads to improve the pharmacy services offered to the patients. <p style="text-align: justify;"><strong>Key word:</strong> Pharmacy leadership, Practice management, Ministry of health, Saudi arabia.

National Survey of Pharmacy Leadership at Ministry of Health in Saudi Arabia: Performances Management

Objective: To explore the national survey of pharmacy leadership at the Ministry of Health with emphasis on pharmacy practice. Methods: It is a ninety days cross-sectional national survey of pharmacy leadership practice at MOH hospitals. The survey modified from self-assessment of 360 leadership and with pharmacy leadership literature. It consisted of a demographic section, leadership pathway, and fifty-three leadership questions. It contained selected eighteen leadership skills of 360 leadership self-assessment.The leadership skills included Achievement, Goals, Flexibility, Feedback, Excellence, Empowering Others, Emotional Intelligence, Decision Making, Developing Others, Cultural Awareness, Continual Improvement, Communication Skills, Coworker Development, Leading the Change Needed, Attitude, Analytical, Administrative Skill, and Action. This survey distributed to all leadership at MOH hospital pharmacies in Kingdom of Saudi Arabia. All analysis is done through the survey monkey system. The survey divided into for several parts for analysis, and discussion. Part one: practice management, part two: planning and organizations, part three: communications strategies, part four: problem-solving and decision making, part five: performances management, part six; working environment, and part seven: professional development. The study explored the part number one; National Survey of Pharmacy leadership: practice management. Results: The survey distributed to one hundred hospitals, the response rate, was forty-two hospitals (42%) with seventy-pharmacy leaders. The gender distribution of responders was Male 43 (63.24%) and female 25 (36.76%) while the nationality was Saudi 69 (98.57%) and non-Saudi 1 (1.43%). The average score Aspects before handling the position was 2.45 (49%) with the highest score was received pharmacy administration orientation 2.57 (51.4%), and the lowest score was received pharmacy administration training courses before handling the positions 2.29 (45.8%). The most sources of gaining skills in pharmacy leadership were life experiences 51 (72.86%) and on job training 29 (41.43%). The average score of administration skills that had pharmacy leaders was 3.63 (72.6%) with the highest score of Communication skills 4.15 (83%), and the lowest score of administration skills was Marketing skills 2.62 (52.4%). Most of the pharmacy leaders had is no incremental of the salary of current positions 44 (67.69%), and most of them got 1-5% only if existed. The majority of pharmacy leaders 29 (43.28%) planned to quit the current position. Conclusion: The pharmacy leadership had low satisfaction at a healthcare organization in Saudi Arabia. Targeting of established very comprehensive leadership program with an emphasis on pharmacy leadership is a requirement for Ministry of Health institutions leads to improve the pharmacy services offered to the patients. Key word: Pharmacy leadership, Practice management, Ministry of health, Saudi arabia.

Effectiveness analysis and inspirations of rational administration of carbapenem

The hospital introduced a multi-department synergy in management of the rational use of carbapenems. Specifically, the medical affairs department conducts training and appraisal of doctors along with a monthly checkup of medical records. The pharmaceutical affairs division conducts prior prescriptions checkup and follow-up comment. The clinical microbiology laboratory and the hospital-acquired infection management department monitors and releases such infection and bacterial resistance information of the whole hospital in real time. The results showed increased prescriptions of imipenem and cilastatin sodium, and decreased prescriptions of biapenem for injection. Drug resistance analysis showed that carbapenem resistant strains increased by 28%, but the total number of patients reduced by 10% and total number of patients with multidrug resistance remained unchanged. It is proposed to further antimicrobial stewardship in the hospital to achieve rational drug use and curb bacterial resistance. Key words: Pharmacy administration; Carbapenem; Antibacterial agent; Rational use

The effect of Housing First on adherence to methadone maintenance treatment

BackgroundOpioid overdose deaths have become a public health crisis in North America, and those who are homeless are particularly vulnerable. Methadone maintenance treatment (MMT) may prevent overdose and death among homeless people with opioid dependence, but suboptimal medication adherence is a common limitation. Previous research found that Housing First (HF) increases antipsychotic medication adherence among formerly homeless people. However, no experimental trials have examined whether HF has a significant impact on MMT adherence. We examined the intervention effect of HF on MMT adherence in a randomized sample of homeless adults experiencing mental illness and opioid dependence in Vancouver, Canada. MethodsComprehensive administrative and self-reported data from homeless adults living with serious mental illness recruited to the Vancouver At Home study were analyzed. Only methadone recipients were included (n = 97). The medication possession ratio (MPR) was utilized as the measure of adherence, and relevant data were obtained from provincial administrative pharmacy records. Study arms were HF and treatment as usual (TAU). Student t-tests were used to test for differences in MMT MPR between HF and TAU. ResultsNo significant differences were observed in MMT MPR between participants in HF and TAU (0.52 vs. 0.57, p = 0.559) in the post-randomization period. ConclusionHF was not associated with significantly different MMT MPR compared to TAU. Additional interventions are indicated as HF alone was insufficient to facilitate improved MMT adherence among formerly homeless adults experiencing concurrent opioid dependence and serious mental illness.

Evaluation of methods used for estimating content validity.

The assessment of content validity is a critical and complex step in the development process of instruments which are frequently used to measure complex constructs in social and administrative pharmacy research. The aims of this study were to investigate the elements of content validity; to describe a practical approach for assessing content validity; and to discuss existing content validity indices. This is a narrative review of the assessment and quantification of content validity. It describes the key stages of conducting the content validation study and discusses the quantification and evaluation of the content validity estimates. Content validity provides evidence about the degree to which elements of an assessment instrument are relevant to and representative of the targeted construct for a particular assessment purpose. The assessment of content validity relies on using a panel of experts to evaluate instrument elements and rate them based on their relevance and representativeness to the content domain. It is a three-stage process that includes; the development stage, judgment and quantifying stage, and revising and reconstruction stage. To quantify the expert judgments, several indices have been discussed in this paper such as the content validity ratio (CVR), content validity index (CVI), modified-Kappa, and some agreement indices. A practical guide describes the process of content validity evaluation is provided. In summary, content validation processes and content validity indices are essential factors in the instrument development process, should be treated and reported as important as other types of construct validation. Determining item CVI and reporting an overall CVI are important components necessary to instruments especially when the instrument is used to measure health outcomes or to guide a clinical decision making. Content validity deserves a rigorous assessment process as the obtained information from this process are invaluable for the quality of the newly developed instrument.

Implementation of an integrated computerized prescriber order-entry system for chemotherapy in a multisite safety-net health system.

The development of a computerized prescriber order-entry (CPOE) system for chemotherapy in a multisite safety-net health system and the challenges to its successful implementation are described. Before CPOE for chemotherapy was first implemented and embedded in the electronic medical record system of Harris Health System (HHS), pharmacy personnel relied on regimen-specific preprinted order sets. However, due to differences in practice styles and workflow logistics, the paper orders across the 3 facilities were mostly site specific, with varying clinical content. Many of these order sets had not been approved by the oncology subcommittee. In addition, disparities in clinical knowledge and lack of communication contributed to inconsistencies in order set development. Led by medical directors from medical oncology departments at the 3 facilities, pharmacy administrators, and information technology representatives, HHS committed resources to supporting the adoption and use of a CPOE system for chemotherapy. Five practical lessons of broad applicability have been learned: engagement of interprofessional stakeholders, optimization of workflow before CPOE implementation, requirement of verification tool for CPOE, consolidation of protocols, and commitment to ongoing training and support. Evaluation of the CPOE system demonstrated a systemwide reduction in medication errors by 75% (p < 0.05). Satisfaction with the CPOE system varied among sites and was unchanged institutionwide 6 months after the CPOE implementation. The development and implementation of CPOE for chemotherapy at a multisite safety-net health system created opportunities to optimize patient care and reduce variations through interprofessional collaborations. Initial evaluation suggested that CPOE reduced the medication-order error rate and improved user satisfaction in 1 of 3 facilities.

Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital.

Purpose: The purpose of this article is to share experiences after the development of a health-system pharmacy administration residency with a MS degree and express the need for additional programs in nonacademic medical center health-system settings. Summary: Experiences with the development and implementation of a health-system pharmacy administration residency at a large community teaching hospital are described. Resident candidates benefit from collaborations with other health-systems through master's degree programs and visibility to leaders at your health-system. Programs benefit from building a pipeline of future pharmacy administrators and by leveraging the skills of residents to contribute to projects and department-wide initiatives. Tools to assist in the implementation of a new pharmacy administration program are also described and include rotation and preceptor development, marketing and recruiting, financial evaluation, and steps to prepare for accreditation. Conclusion: Health-system pharmacy administration residents provide the opportunity to build a pipeline of high-quality leaders, provide high-level project involvement, and produce a positive return on investment (ROI) for health-systems. These programs should be explored in academic and nonacademic-based health-systems.

Relocating patients from a specialist homeless healthcare centre to general practices: a multi-perspective study.

The relocation of formerly homeless patients eligible to transfer from a specialist homeless healthcare centre (SHHC) to mainstream general practices is key to patient integration in the local community. Failure to transition patients conferring eligibility for relocation may also negatively impact on SHHC service delivery. To explore barriers and facilitators of relocation from the perspectives of formerly homeless patients and healthcare staff involved in their care. Qualitative semi-structured face-to-face and telephone interviews conducted in the north east of Scotland. Participants were patients and healthcare staff including GPs, nurses, substance misuse workers, administrative, and local community pharmacy staff recruited from one SHHC, two mainstream general practices, and four community pharmacies. Interview schedules based on the 14 domains of the Theoretical Domains Framework (TDF) were drafted. Transcripts of the interviews were analysed by two independent researchers using a framework approach. Seventeen patients and 19 staff participated. Key barriers and facilitators aligned to TDF domains included: beliefs about consequences regarding relocation; patient intention to relocate; environmental context and resources in relation to the care of the patients and assessing patient eligibility; patient skills in relation to integration; social and professional role and identity of staff and patients; and emotional attachment to the SHHC. Implementation of services, which promote relocation and integration, may optimise patient relocation from SHHCs to mainstream general practices. These include peer support networks for patients, better information provision on the relocation process, and supporting patients in the journey of identifying and adjusting to mainstream practices.

TELEPHARMACY RULES AND STATUTES: A 50-STATE SURVEY

Purpose and Introduction. The purpose of this policy brief is to identify rules and laws enacted by states authorizing the use of community telepharmacy initiatives within their respective jurisdictions. Though telepharmacy exists in several forms, telepharmacy in this brief is defined as the delivery of pharmaceutical care to outpatients at a distance through the use of telecommunication and other advanced technologies. Pharmaceutical care includes, but is not limited to, drug review and monitoring, dispensing of medications, medication therapy management, and patient counseling. A significant advantage of telepharmacy is the ability to provide pharmacist access to patients in remote areas where a pharmacist is not physically available. Therefore, the implications of telepharmacy on increasing access to care are significant, particularly to patients in underserved rural communities, though it is important to note that underserved populations do not exist exclusively in rural settings. Key Findings. (1) The use of telepharmacy is authorized, in varying capacities, in 23 states (46 percent). (2) Pilot program development that could apply to telepharmacy initiatives is authorized by six states (12 percent). (3) Waivers to administrative or legislative pharmacy practice requirements that could allow for telepharmacy initiatives are permitted in five states (10 percent). (4) Nearly one-third of the states (16, or 32 percent) do not authorize the use of telepharmacy, nor do they currently have the ability to pursue telepharmacy initiatives via pilot programs or waivers.

Controller therapy in Asians and whites with persistent Asthma.

Little is known concerning the relative effectiveness of LTRAs compared to ICSs as monotherapy or LABA as add-on therapy in the Asian population. In this retrospective cohort study, we examined the comparative effectiveness of montelukast to ICS as a first-line monotherapy and as an add-on in comparison with LABA on asthma exacerbations among Asian and non -Hispanic white persistent asthma patients in a large managed care organization. The three add-on comparisons were montelukast plus low-dose ICS versus LABA plus low-dose ICS, montelukast plus low-dose ICS versus medium-dose ICS, and montelukast plus medium-dose ICS versus LABA plus medium-dose ICS. Patients were identified based on ICD-9 diagnosis codes and administrative pharmacy dispensing. Exacerbations were defined as asthma emergency department visit or hospitalization, or asthma outpatient visits requiring systemic corticosteroid dispensing. Patient demographic and clinical characteristics were balanced by using inverse probability treatment weighting. Multivariable robust Poisson and Cox-proportional hazards regression models were applied to estimate rate ratios and hazard ratios. Compared with low-dose ICS monotherapy, montelukast monotherapy evidenced a lower incidence rate (RR 0.89, CI 0.79-0.99, p = 0.03) but similar hazard rate (HR 0.96, CI 0.86-1.06, p = 0.43) of asthma exacerbation in white patients 12 years of age or older. No difference was observed in Asian patients or in white children 4-11 years of age. All other comparisons did not reveal a statistically significant difference in incidence or hazard rate. In a real-world comparative effectiveness study, asthma exacerbation rates were similar among guideline alternative controller regimens in Asians and whites.

Sensitivity of the Medication Possession Ratio to Modelling Decisions in Large Claims Databases.

When preparing administrative medical and pharmacy claims data for analysis, decisions about data clean up and analytical approach need to be made. However, information about the effects of various modelling decisions on adherence measures such as the medication possession ratio (MPR) is limited. We address this gap with this study. We utilized cross-sectional administrative claims data for commercially insured members filling at least two prescriptions for drugs within five classes of hypertension medication between 2008 and 2010. We divided nine modelling decisions into three categories: data scrubbing, study design, and MPR definition/calculations. We defined the base-case settings with commonly used values, varied each modelling decision singly and in combination, and measured the effects on the MPR. Claims data for 358,418 individuals were available for analysis. Two modelling decisions were found to be highly influential, each yielding a difference of over 25 percentage points from the base case: the decision of whether to use interval- or prescription-based study periods, and the decision of how to handle overlapping prescription claims. The effect of other decisions was smaller, with a difference of 1-9 percentage points from the base case. Some of the decisions considered had a large impact on the MPR. Therefore, it is important for researchers to standardize approaches for study period length and overlapping prescription claims. We also conclude that transparent reporting of modelling decisions will facilitate the interpretation of results and comparisons across studies.

Predictors of linkage to HIV care and viral suppression after release from jails and prisons: a retrospective cohort study

Incarceration provides an opportunity for engagement in HIV care but is associated with poor HIV treatment outcomes after release. We aimed to assess post-release linkage to HIV care (LTC) and the effect of transitional case management services. To create a retrospective cohort of all adults with HIV released from jails and prisons in Connecticut, USA (2007-14), we linked administrative custody and pharmacy databases with mandatory HIV/AIDS surveillance monitoring and case management data. We examined time to LTC (defined as first viral load measurement after release) and viral suppression at LTC. We used generalised estimating equations to show predictors of LTC within 14 days and 30 days of release. Among 3302 incarceration periods for 1350 individuals between 2007 and 2014, 672 (21%) of 3181 periods had LTC within 14 days of release, 1042 (34%) of 3064 had LTC within 30 days of release, and 301 (29%) of 1042 had detectable viral loads at LTC. Factors positively associated with LTC within 14 days of release are intermediate (31-364 days) incarceration duration (adjusted odds ratio 1·52; 95% CI 1·19-1·95), and transitional case management (1·65; 1·36-1·99), receipt of antiretroviral therapy during incarceration (1·39; 1·11-1·74), and two or more medical comorbidities (1·86; 1·48-2·36). Reincarceration (0·70; 0·56-0·88) and conditional release (0·62; 0·50-0·78) were negatively associated with LTC within 14 days. Hispanic ethnicity, bonded release, and psychiatric comorbidity were also associated with LTC within 30 days but reincarceration was not. LTC after release is suboptimal but improves when inmates' medical, psychiatric, and case management needs are identified and addressed before release. People who are rapidly cycling through jail facilities are particularly vulnerable to missed linkage opportunities. The use of integrated programmes to align justice and health-care goals has great potential to improve long-term HIV treatment outcomes. US National Institutes of Health.

Jack E. Brown, researcher and AJHP contributing editor, dies at 48.

Jack E. Brown, Jr., associate professor and chairman of the department of pharmacy practice and administration at the St. John Fisher College Wegmans School of Pharmacy in Rochester, New York, died unexpectedly on November 2. He was 48 years old. Brown was an infectious diseases (ID)–trained researcher and a prolific author. He joined the faculty of Wegmans School of Pharmacy in 2013 after serving as associate professor of pharmacy, medicine, and public health at University at Buffalo, The State University of New York. His earlier career included research and education roles at the University of Connecticut College of Pharmacy in Storrs, at Dartmouth Medical School in New Hampshire, and at Cubist Pharmaceuticals in Lexington, Massachusetts. “He was the kindest person; he always put others first,” said Deborah Goff, associate professor in infectious diseases at the Ohio State University (OSU) Medical Center in Columbus. “He was also a gifted educator. He loved teaching.”

Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience.

Purpose: The purpose of this study was to utilize lean process improvement principles to enhance the health-system pharmacy administration learning experience within a postgraduate year 1 (PGY1) residency program. Summary: The Richard L. Roudebush VA Medical Center adopted the use of lean to improve customer service and workplace efficiency. The Residency Advisory Council, overseeing the 6 pharmacy residency programs, felt that training residents in a proven process improvement technique would benefit the service and assist in developing problem-solving skills. Yellow Belt training was incorporated into the residency programs in 2012, and the Yellow Belt project for the 2014-2015 residency class was the modification of the PGY1 Health-System Pharmacy Administration learning experience. Residents focused on a few key areas as part of their completion plan: educating residents and preceptors on the importance of leadership activities, establishing a list of consistent topic discussions to be held during the administration learning experience, confirming a topic list for the pharmacy practice management and leadership seminars, piloting collaborative precepting for the administration experience, revising the staff development program, and increasing resident involvement in the PGY1 interview process. Two portions of the project lacked effective and timely communication, and as a result, those areas were not fully implemented. The remainder of the items achieved 100% completion. Conclusion: Lean techniques were effectively utilized within a residency program to enhance the health-system pharmacy administration learning experience. Successful implementation of lean requires engagement of stakeholders within the health-system, timely communication, frequent reassessments, and accountability.

Relationship of Blood Eosinophil Count to Exacerbations in Chronic Obstructive Pulmonary Disease

Eosinophilic airway inflammation characterizes a chronic obstructive pulmonary disease (COPD) phenotype that requires more study. To investigate the relationship of blood eosinophil count to exacerbations in COPD. Using administrative pharmacy and health care utilization data from 2009 to 2012, we retrospectively identified patients 40 years or older with a COPD diagnosis, postbronchodilator FEV1/forced vital capacity ratio of less than 0.7, and a blood eosinophil count (N= 7,245). COPD exacerbations were defined as hospitalizations or emergency department visits with a primary diagnosis of COPD, or outpatient visits with systemic corticosteroid dispensing within ±14 days associated with an encounter code consistent with a COPD exacerbation. The relationship between the index blood eosinophil count and the rate of COPD exacerbations in the follow-up year was determined by multivariable analyses. Patients with COPD were predominantly male (57.1%), white (71.8%), often current or past smokers (75.4%), and had frequent comorbidities; 19.0% had eosinophil counts of greater than or equal to 300 cells/mm3, 76.1% were classified as moderate to very severe by lung function, and the COPD exacerbation rate was 0.38 per year (95% CI, 0.37-0.40). After adjustment for potential confounders, COPD exacerbations during 1-year follow-up were significantly greater for patients with blood eosinophil counts of greater than or equal to 300 cells/mm3 (rate ratio [RR], 1.25; 95% CI, 1.10-1.43), greater than or equal to 400 cells/mm3 (RR, 1.48; 95% CI, 1.26-1.75), and greater than or equal to 500 cells/mm3 (RR, 1.76; 95% CI, 1.45-2.14), respectively, compared with patients with eosinophils lower than the cutoffs. In this study, high blood eosinophil counts were an independent risk factor for future exacerbations in patients with COPD, a phenotype that might benefit from therapy directed at eosinophilic-driven disease and inflammation.

EVALUASI TINGKAT KESESUAIAN STANDAR AKREDITASI TERHADAP PELAYANAN FARMASI DAN STRATEGI PERBAIKAN DENGAN METODE HANLON DI RSUD KABUPATEN BIMA

Getting maximal service represent dream all society especially receiver of service of the hospital including in pharmacy installation. Patient got many problems because service not yet fulfilled standard. To fulfill requirement of patient, pharmacy installation have to this research accredit to know storey level according to seven accreditation standard to service of pharmacy in RSUD Sub Province Bima and repair strategy with Hanlon method. This Research use instrument of quizioner Depkes and special informan interview counted 15 informan and people lock counted 3 people. Subject at this research is all officer in concerned and have important role in pharmacy Installation RSUD Sub Province Bima. Conducted by assessment seven standard later then compared to between informan with result of observation, afterwards analyzed by strategy development by using Hanlon method. Result of Research of show there are difference of result assessment of standard accredit between officer of pharmacy Installation that is ( 58,75%) with research that is ( 55%). From seventh of accreditation standard, nothing that fulfill accreditation standard (&lt; 60%), result strategy development with Hanlon method is Facility and equipments, repair of facilities and basic facilities of Pharmacy administration management and, immediately do function KFT . Evaluation and quality control, require to make pharmacy program written and also SK about meeting schedule .Philosophy and target, SK about policy of pharmacy service from Hospital head. Policy and procedure, making SOP and policy written about management of provisions of pharmacy . Development of education program and staff, done by education program and periodical training in IFRS. STAF and head, existence of staff pharmacy performance evaluation and orientation to officer of Installation Pharmacy

LC-MS/MS application in pain management

Pain management is the monitoring of chronic pain patients under long-term treatment with controlled analgesic drugs via random or regular lab tests. Plenty of clinical data showed that pain management could not only improve the patient′s compliance to prescribed drugs and result in better outcome, but also greatly reduce the possibility of controlled analgesic drugs into the underground market illegally. Drugs that are usually internationally recommended in pain management include opiates, opioids, sedative drugs, stimulant, hallucinogens etc. Considering drug metabolism rates difference among individuals and ease of sampling, random urine is usually the first choice of specimen for drug testing in pain management. In terms of methodology, LC-MS/MS has become a gold standard approach due to its high sensitivity, high specificity and wide usability.(Chin J Lab Med, 2017, 40: 829-834) Key words: Analgesics; Drug monitoring; Chromatography, liquid; Tandem mass spectrometry; Pharmacy administration