Pharmacy Administration Research Articles

Pharmacy administration and pharmaceutical care practice in a module hospital during the COVID-19 epidemic

ObjectivesTo describe the pharmacy administration and pharmaceutical care in a module hospital during the coronavirus disease 2019 (COVID-19) epidemic and provide reference for domestic and foreign pharmacists participating in the epidemic prevention and control. SettingThe study was performed in a Jianghan module hospital constructed at the Wuhan Convention and Exhibition Center in Wuhan, China. This is 1 of the first 3 module hospitals. Practice descriptionOne thousand eight hundred forty-eight patients were admitted to the Jianghan module hospital, and 1327 cases (71.81% of the total number) were cured and discharged. Pharmacists have successfully completed the tasks of purchase, storage, and free distribution of drugs worth ¥1.03 million (approximately $146,000), reviewed about 20,000 electronic orders, provided one-on-one online medication consultation for 484 patients, and held 5 lectures on rational drug use knowledge, which could help reduce irrational drug use and minimize the risk involved. Practice innovationThe new COVID-19 “module” pharmaceutical care model is equipped with new features such as pharmacy emergency command group, organizational structure for pharmacy administration, electronic control of drug prescription, and “zero contact” pharmaceutical care relying on the new media platform “WeChat.” This platform provides relevant pharmaceutical care for patients, such as ensuring drug supply, setting up critical care drug trolleys, designing specific drug packaging bags, creating a module radio station to broadcast rational drug use information to the patients, and other aspects. EvaluationWith the continuous improvement of the module hospital and the progress in in-depth knowledge about COVID-19, some aspects such as patient admission criteria and variety of drugs need to be adjusted depending on the actual situation. ResultsThe pharmacists provided pharmaceutical care for 1848 patients with mild COVID-19 disease. They not only ensured the timely supply of the drugs but also reduced the incidence of drug-induced risks through medication review and guidance, thereby improving patient compliance and helping the patients rebuild their confidence in overcoming the disease. ConclusionThe new COVID-19 module pharmaceutical care model has played an important role in overcoming the epidemic situation of COVID-19 in China and thus can be implemented on a broader scale.

Pharmaceutical administration practice during prevention and treatment of COVID-19

January 25, 2020, our hospital was served as the designated hospital for critically ill patients with new coronary pneumonia in Wuhan. The timely and effective pharmaceutical emergency protection system was great significance for epidemic prevention. In order to ensure the drug demand of patients and improve the level of drug treatment, the key and difficult issues in the practice of administration during new coronary pneumonia were combined with clinical practical work to develop an appropriate pharmaceutical emergency support system. Our department launched the emergency response mechanism, such as established list of COVID-19 key therapeutic drugs, urgently purchased therapeutic drugs, reformed the processes of emergency pharmacy, established a donated drug management system, establish the COVID-19 pharmaceutical care team, and opened a cloud pharmacy to meet the drug needs of non COVID-19 chronic diseases patients. We also strengthened the management of personnel protection. The administration during new coronary pneumonia is a professional, comprehensive, complex and systematic emergency project that guarantees the safety of drug supply, medication and enables the treatment work to be carried out in an orderly manner. Key words: COVID-19; Pharmacy administration; Clinical safe medication; COVID-19 hospital

Privileges of Pharmacist in Saudi Arabia: Administration and Management

PTB Reports,2020,6,1,7-12.DOI:10.5530/PTB.2020.6.2Published:March 2020Type:Research ArticleAuthors:Faisal Al-Otaibi, Mohamed Soliman Imam, Randa Mansour Abdel-Sattar Ahmed, Amsha Alotaibi, Asma Alotaibi, Amal Alotaibi, Wesam Alsuwaid, and Yousef Ahmed Alomi Author(s) affiliations:Faisal Al-Otaibi, Ph. D, Assistant Professor, College of Pharmacy, Pharmacy Patrice Department, Shaqra University, Saudi Arabia. Mohamed Soliman Imam, Ph. D, Assistant Professor, Dean, College of Pharmacy, Shaqra University, Saudi Arabia. Randa Mansour Abdel-Sattar Ahmed, Ph.D, Biomedical Science Department, College of Pharmacy, Shaqra University, Saudi Arabia. Amsha Alotaibi, Pharm D, Clinical Pharmacist, College of Pharmacy, Pharmacy Patrice Department, Shaqra University, Riyadh, Saudi Arabia. Asma Alotaibi, Pharm D, Clinical Pharmacist, College of Pharmacy, Pharmacy Practice Department, Shaqra University, Saudi Arabia. Amal Alotaibi, Pharm D, Clinical Pharmacist, College of Pharmacy, Shaqra University, Saudi Arabia. Wesam Alsuwaid, Pharm D, Clinical Pharmacist, College of Pharmacy, Pharmacy Practice Department, Shaqra University, Saudi Arabia. Yousef Ahmed Alomi*, BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE, Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor and Data Analyst, P.O.BOX 100, Riyadh, Saudi Arabia. Abstract:Objectives: To explore the privileges of pharmacists through the pharmacy administration and management in Saudi Arabia. Methods: This is a 4-month cross-sectional survey regarding the privileges of pharmacists in Saudi Arabia. The study consisted of two parts: the first part collected demographic information and the second part comprised a questionnaire with 28 questions divided into 4 domains. The questions were derived from previous literature and from the regulatory standards of the American Society of Health-System Pharmacists (ASHP). The four domains were as follows: privilege management and resources, pharmacist prescribing and therapeutic interchange, clinical and administration privilege and drug monitoring and healthcare education. The responses were obtained using a 5-point Likert response scale system with close- and open-ended questions. The survey questionnaire was distributed in an electronic format to the hospital’s director of pharmacy of each hospital in Saudi Arabia. In this study, we analyzed pharmacist’s privilege in Saudi Arabia with regard to the pharmacy administration and management. All data were obtained through the Survey Monkey system. Results: The survey was distributed to 36 hospitals. The administration-related elements of pharmacist privilege with maximum score were policies and procedures of pharmacist’s privilege (3.88 (77.6%)) followed by the vision of pharmacist privilege (3.57 (71.4%)) and pharmacist privilege in the job description (3.56 (71.2%)). The average score of pharmacist privilege in the hospital committees was 3.47 (69.40%). Most of the committees having pharmacist privilege was the patient or medication safety committee (4.09 (81.8%)) followed by the pharmacy and therapeutic committee (4.06 (81.2%)) and quality management committee (4.06 (81.2%)). The average score of pharmacist privilege in the teams was 3.44 (68.85%). The majority of the teams having pharmacist privilege was antibiotics team (4.25 (85%)) followed by anticoagulation team (3.86 (77.2%)) and IV therapy team (3.81 (76.2%)). Conclusion: The privileges of a pharmacists is inadequate in the Kingdom of Saudi Arabia. Future programs should target to improve the healthcare system and expand pharmacists’ role in the hospital practice. This might improve the pharmaceutical care services and patient outcomes and prevent drug-related problems and unnecessary economic expenditure on the healthcare practice in Saudi Arabia. Keywords:Administration, Management, Pharmacist, Privileges, Saudi ArabiaView:PDF (213.19 KB) PDF PDF Images Responders’ experiences of pharmacy practice

Improving clinic utilization and workload capture for clinical pharmacy specialists.

To assess a quality improvement initiative aimed at improving clinic utilization and encounter and intervention workload capture for clinical pharmacy specialists. This initiative aided in justification of clinical pharmacy services, identification of clinical areas for intervention, and incorporation of all modalities to appropriately document clinical care. In order to objectively demonstrate clinical pharmacy service value to stakeholders, pharmacy administrators and clinical pharmacy specialists at the North Florida/South Georgia Veterans Health System performed clinic scheduling and profile reviews using data extracted from the Veterans Health Administration electronic health record and analytic software. Outpatient clinical pharmacy specialty practice areas were primarily investigated; the specialty areas included are as follows: cardiology, infectious disease, mental health, oncology, pain management/palliative care, and specialty clinics (a collection of medical and surgical subspecialties). The first intervention entailed completing a worksheet and assessing clinic utilization data. Then, an evaluation was performed to assess the number of encounters, clinical interventions, clinic modalities, and coding for each clinic. Next, a meeting was arranged with each like clinical pharmacy specialist practice group to discuss this collected data. During these meetings, the delineation of where workload was generated and the activities taking place in an average workday were discussed. Finally, clinics were adjusted to reflect appropriate clinic coding and mapping of the average workday. Metrics were evaluated pre intervention (October through December 2017) and post intervention (July through September 2018). After intervention, there were statistically significant increases in clinic utilization, total encounters completed, and total interventions recorded in the composite group of clinical pharmacy specialists. The increases in clinic utilization, total encounters, and interventions observed for the clinical pharmacy specialists suggest the beneficial role of pharmacy administrators' collaboration with clinical pharmacy specialists to improve workload capture and access to quality care, to justify clinical pharmacy services, and to identify opportunities for pharmacy clinical intervention.

Burden of Specialist-Diagnosed Chronic Cough in Adults

The burden of chronic cough (CC) in patients seeking specialist care is infrequently researched. To describe patient characteristics and disease burden associated with specialist-diagnosed CC. Using administrative pharmacy and medical data, we identified patients aged 18 to 85 years with CC diagnosed by pulmonologists, allergists, otolaryngologists, or gastroenterologists. Patients were stratified into 4 subgroups on the basis of the presence or absence of common respiratory diseases or gastroesophageal reflux disease (GERD). Clinical features and health care resource utilization (HCRU) in the baseline and outcome years were compared between the CC subgroups. The baseline factors associated with persistence of CC and a comparison of the CC cohort to a matched noncough cohort were also determined. The 11,290 patients with specialist-diagnosed CC were aged about 61 years and 66.7% were females. The CC cohort experienced frequent GERD (44.1%), asthma (31.2%), obesity (24.3%), upper airway cough syndrome (20.4%), common cough complications (19.4%), and hospitalizations (9.8%). The patients with CC with both respiratory disease and GERD exhibited at baseline and follow-up the most common cough comorbidities, higher HCRU, specialist care, and dispensed respiratory and nonrespiratory medications including proton pump inhibitors, antitussives, psychotherapeutics, oral corticosteroids, and antibiotics compared with the other subgroups. A 40.6% persistence of CC occurred similarly between CC subgroups. In addition, patients with CC in the matched analysis experienced significantly more comorbidities, laboratory evaluations, HCRU, and antitussives than patients without cough. Specialist-diagnosed CC was associated with considerable disease burden, particularly among those with both respiratory disease and GERD. In addition, CC burden was more pronounced than in matched patients without cough.

Survey of health-system pharmacy administration and leadership residencies.

To perform an inquiry with response measurement from health-system pharmacy administration and leadership (HSPAL) residency program directors and residents to distinguish variances between the programs and identify enhancement opportunities for key stakeholders. Members from the Pharmacy Administration Resident Collaboration Research Committee developed separate 20-question survey instruments to assess the strengths and areas of opportunity for HSPAL residency programs from the perspective of residency program directors and residents. The survey instruments were designed to evaluate the level of pharmacy service integration across HSPAL programs nationwide. Nearly half of the residency program directors within the listserv (40.74%, 33/81) participated in the survey. The recognized areas of opportunity by residency program directors include community pharmacy leadership, professional organization involvement, sterile compounding, and supply chain management. About a third (32.54%, 41/126) of the residents participated in the survey. Residents reported the least exposure to community pharmacy leadership, human resource management, informatics, professional organizations, and ambulatory care/specialty rotations. The overall recommendations for HSPAL residency programs are to incorporate C-suite-level experiences, improve alumni engagement, develop longitudinal human resource/financial experiences, and encourage resident credential obtainment. In order to foster professional and leadership growth for HSPAL residents, residency programs should consider incorporating C-suite-level experiences, longitudinal human resource/finance experiences, alumni engagement opportunities, rotation variety, professional organization involvement, and support in credential obtainment.

Changes in Concurrent Opioid and Benzodiazepine Use Following a Low-Touch Prescriber Fax Intervention.

Concurrent use of opioids and benzodiazepines (COB) can lead to additive respiratory and central nervous system effects, putting patients at increased risk of fatal overdose. In 2016, the Centers for Disease Control and Prevention released an opioid-prescribing guideline recommending against COB, and the Pharmacy Quality Alliance (PQA) endorsed a COB measure in its core opioid set. From May 1, 2017, to December 4, 2017, a California Medicaid plan launched a COB-focused prescriber outreach intervention for members receiving recent opioid and benzodiazepine claims with the intent of decreasing concurrent use. To assess the effect of a prescriber fax intervention by a Medicaid plan on COB. Two retrospective analyses were conducted using administrative pharmacy claims data: a comparison of the PQA COB rate among selected California Medicaid plans for 2016 and 2017 and a cohort utilization analysis of members identified for the fax intervention compared with controls. Intervention and control members were matched based on 12 pre-index utilization characteristics. Outcomes assessed included proportion of members with resolution of COB in the post-index period, change in mean number of COB days before and after the index date, and proportion of members with decreased benzodiazepine daily dose after the index date. Analyses were also performed for the subgroups of members with < 30 days of COB and ≥ 30 days of COB in the pre-index period. All California Medicaid plans in the study saw an improvement in the PQA COB rate between 2016 and 2017. In the utilization analysis, 4,182 intervention members were eligible according to study criteria and matched to similar control members. Many differences in medication use existed between the subgroups with < 30 days and ≥ 30 days of COB in the pre-index period, with the latter group consisting of much more chronic, complex users. The intervention cohort had a statistically significant higher proportion of members with complete resolution of COB compared with the control cohort (43.8% vs. 40.0%; P < 0.01), which was also statistically significant for the 2 subgroups. The intervention cohort had a decrease in the mean number of COB days from pre- to post-index periods, but this was only statistically significant for the subgroup with < 30 COB days (-2.5 vs. -1.5; P = 0.0217). No statistically significant differences were detected between cohorts in proportion of members with decreased benzodiazepine dose. Our analyses demonstrated that this low-touch prescriber fax intervention produced statistically significant improvements in COB outcomes, despite the overall trend of declining COB among the other California Medicaid plans. Low-touch, targeted prescriber outreach can be an inexpensive yet effective tool to affect prescriber behavior, particularly before COB becomes chronic. No outside funding was used to support this study. The authors do not have any financial relationships or potential conflicts of interest relevant to this article to disclose. At the time of conducting this research, all authors were employees of MedImpact Healthcare Systems. The results of this study were presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2019; March 25-28, 2019; San Diego, CA.

Bachelor of pharmacy graduates' perceptions of the pharmacy administration curriculum in Trinidad and Tobago

IntroductionAs the profession of pharmacy has evolved, pharmacy education has developed to include competencies and skills related to pharmacy administration services. Competencies taught in pharmacy administration courses are expected to provide graduates with skills to effectively undertake administrative functions. Our study aimed to assess perceptions about knowledge and skills gained by the pharmacists during the Pharmacy Administration course at the School of Pharmacy, the University of the West Indies (UWI), Trinidad and Tobago. MethodsA cross-sectional survey was carried out among pharmacists working in hospitals and community pharmacies in Trinidad using non-probability convenience sampling. A structured questionnaire was distributed to 262 pharmacists who completed the Pharmacy Administration course. Two-hundred eighteen (83%) usable responses were included for analysis. ResultsMany (45.4%) respondents agreed that the course provided them with the knowledge of running a business, 78% said they were able to apply the skills in their practice, and 80% mentioned that the course should be mandatory. Pharmacists found that the course on business management enhanced their knowledge in the fields of managing human resources, conflict management, marketing, project management, corporate turnaround, inventory, and financial management. ConclusionsThe Pharmacy Administration course in the bachelor of science degree in pharmacy programme at the School of Pharmacy, UWI remains relevant in the areas of marketing, human resource management, and inventory management. The programme can be extended to a full time masters course to interested pharmacy graduates.

Pharmapreneur – Defining a Framework for Entrepreneurship in Pharmacy Education

Objective. To determine the role of entrepreneurism within the broader missions of schools of pharmacy and develop an educational framework to produce pharmacist entrepreneurs. Methods. Following a systematic review and six semi-structured interviews, a three-round Delphi process was conducted with an expert panel comprised of successful entrepreneurs, pharmacy faculty members and administrators, students, and community members. Participants were asked about the role of entrepreneurship in a pharmacy school's mission, how they would define a pharmacist entrepreneur, and to identify the knowledge, skills, and attitudes (KSAs) expected to be successful as a pharmacist entrepreneur. A model for entrepreneur education was also developed in accordance with Bloom's taxonomy. Participant agreement and rankings were reported. Results. Based on the semi-structured interviews and the results from the Delphi process, the following framework for a pharmacist entrepreneur was proposed along with a list of KSAs: identifies, creates, and pursues new opportunities; successfully implements new ideas into practice; is willing to take risks; fills unmet needs; creates new value through innovation; is responsive to change; makes sacrifices; includes social and intrapreneurship; leverages existing knowledge, skills, and resources; goes beyond traditional roles for pharmacists; and improves patient care. Recommendations for entrepreneurship instruction, guided by Bloom's taxonomy of cognitive processes, were created. Conclusion. According to our expert panel, a pharmacist entrepreneur combines several characteristics identified with a more traditional entrepreneur construct with the characteristics of an individual devoted to achieving outcomes beyond one's personal gain. Additional research to inform implementation and assessment of entrepreneurship within pharmacy curricula would provide more specific guidance for instructional design and accreditation evaluations.

Validation of a Cyclic Algorithm to Proxy Number of Lines of Systemic Cancer Therapy Using Administrative Data.

Researchers are automating the process for identifying the number of lines of systemic cancer therapy received by patients. To date, algorithm development has involved manual modifications to predefined classification rules. In this study, we propose a supervised learning algorithm for determining the best-performing proxy for number of lines of therapy and validate this approach in four patient groups. We retrospectively analyzed BC Cancer pharmacy records from patients' cancer diagnosis until end of follow-up (cohort-specific, 2014/2015). We created and validated a cyclic algorithm in patients with advanced cancers of varying histologies, diffuse large B-cell lymphoma, follicular lymphoma, and chronic lymphocytic leukemia. To assess internal and external validity, we used a split-sample approach for all analyses and considered lines of therapy identified through manual review as our criterion standard. We measured agreement using correlation coefficients, mean squared error, nonparametric hypothesis testing, and quantile-quantile plots. Cohorts comprised 91 patients with advanced cancers, 121 with chronic lymphocytic leukemia, 440 with follicular lymphoma, and 679 with diffuse large B-cell lymphoma. Number of lines of therapy received and patients' treatment period length varied substantially across cohorts. Despite these differences, our algorithm successfully identified a best-performing proxy for number of lines of therapy for each cohort, which was moderate to highly correlated with (within-sample: 0.73 ≤ Pearson correlation ≤ 0.84; out-of-sample: 0.52 ≤ Pearson correlation ≤ 0.76) and whose distribution did not significantly differ from the criterion standard within or out of sample (P > .10). Supervised learning is an ideal tool for generating a best-performing proxy that recognizes prescription drug patterns and approximates number of lines of therapy. Our cyclic approach can be used in jurisdictions with access to administrative pharmacy data.

Rescheduling hydrocodone combination products: Impact on patients receiving long-term HCP therapy in a large chain pharmacy—A statewide assessment

ObjectiveThis study aimed to evaluate the rescheduling of hydrocodone combination products (HCPs) from schedule III (CIII) to schedule II (CII) in patients receiving chronic HCP therapy. MethodsThis study was a retrospective cohort analysis of administrative pharmacy data from 118 statewide pharmacies from a retail chain in Tennessee. HCP filling histories were analyzed on patients meeting enrollment criteria from July 1, 2014, to October 1, 2015. The average number of tablets dispensed, daily average of the number of tablets dispensed, and monthly average of morphine milligram equivalents (MME) dispensed were compared for the periods of July 1, 2014, to October 5, 2014 (enrollment period before schedule change) and October 6, 2014, to October 1, 2015 (period following schedule change) using a pooled t test. ResultsA total of 4536 patients met the inclusion criteria. Of these 4536 patients, 60.6% were female, and 40.4% were male, with an average age of 58 years (patients included in this study were between the ages of 18 and 99 years). The total number of hydrocodone tablets dispensed in the 12 periods after the schedule change dropped from 467,217 to 259,327, a 45.5% reduction (P < 0.001). Total MME decreased from 4.11 to 2.29 million, a 45.3% reduction (P < 0.001). The number of study participants still receiving an HCP at the end of the study decreased to an average of 2736 across the 12 periods following the schedule change, a 40% reduction. ConclusionHCP dispensing and use decreased among patients receiving chronic opioid treatment from a large corporate statewide community pharmacy in Tennessee after a schedule change from CIII to CII. Monthly sums of total tablets dispensed, average daily tablets dispensed, MME, and average daily MME calculated from July 1, 2014, to October 1, 2015, all experienced statistically significant reductions.

PHARMACEAUTICAL CARE IMPROVED THE QUALITY OF LIFE OF PATIENT WITH HEMODIALYSIS

Objective: Patients undergoing hemodialysis in the long term often experience complications that affect the quality of life (QOL) of the patients. Comprehensive health services are very important for improving the QOL of the patients with chronic renal failure undergoing hemodialysis. The purpose of this study was to prove that the provision of therapy with pharmaceutical care can improve the QOL of hemodialysis patients.&#x0D; Methods: This research was a quasi-experimental study pre and post test design. Samples were recruited applying the purposive sampling method. As many as 50 patients met the inclusion criteria and were asked to fill out the World Health Organization Quality Of Life (WHOQOL) questionnaire to measure their QOLs before and after the provisions of pharmaceutical care. Data obtained before and after pharmaceutical care were tested using paired t test, person correlation test, and Wilcoxon test in the program of SPSS 19.&#x0D; Results: The results showed women more often experience complications when hemodialysis (62%), sex with quality of life (p = 0.907), education with quality of life (p = 0.277), work with quality of life (p = 0.582) length of undergoing hemodialysis with quality life (p = 0.733) no significant effect. Age (p = 0.044) significantly influences quality of life. And the average quality of life before administration of pharmacy and care was 48.12±5.98, while the quality of life after administration of therapy with pharmaceutical care was 50.16±6.22. Based on the Wilcoxon test, this value was significantly different (p = 0.009).&#x0D; Conclusion: The conclusion of this study is the provision of therapy accompanied by pharmaceutical care significantly improves the quality of life of hemodialysis patients.

PNS182 SYSTEMIC ADMINISTRATION OF GLUCOCORTICOIDS IN GUIZHOU PROVINCE, CHINA: A SURVEY AMONG HOSPITAL PHARMACIES.

To investigate the status of GCs use as systemic medication in Guizhou Province, China and evaluate the effectiveness of current management interventions for GCs. The study was based on the Quality Control Center of Guizhou Pharmacy Administration and conducted by sending questionnaires to the member hospitals within Guizhou Province. Chi-square test and analysis of variance were used in univariate analysis, while logistic regression and multiple linear regression were applied in multivariate analysis. This survey included 271 hospitals in Guizhou Province. The average number of prescriptions on systemic use of GCs was 2.18 [95%CI (credible interval: 1.83-2.59)] per 100 outpatients prescriptions, with an average dose of 10.19 (95%CI: 8.50-12.21) mg per visit (calculated by hydrocortisone) in 2018. Fifty-one hospitals (18.82%), especially in Grass-roots Healthcare Centers (GHC) (34/51), considered fever and pain caused by common infections as the main indication for systemic administration of GCs. Multivariate analyses suggested that current management interventions for GCs had little effect on the rational use of GCs (P＞0.05). The status of irrational use of GCs in Guizhou Province is alerting, especially in GHC. It is necessary to restrict the indication for GCs use and improve the management.

Association between student characteristics and rankings when applying for a residency in health-system pharmacy administration.

Results of a study to identify characteristics associated with pharmacy residency applicant success in obtaining an invitation to interview and a top candidate ranking are reported. Subsequent development and initial validation of a predictive model based on those characteristics are described. Bivariable analyses were performed for planned stratifications of applicants to a health-system pharmacy administration residency program according to whether they were offered an on-site interview or were among the 8 top candidates by final candidate ranking. A Random Forest algorithm was created to identify predictors of the likelihood of an applicant being offered an on-site interview. Applicants who were offered interviews had a higher median pharmacy school grade point average (GPA) than those not invited to interview: 3.63 (interquartile range [IQR], 3.46-3.79) versus 3.35 (IQR, 3.2-3.49); p < 0.001. Invited applicants also received more scholarships during pharmacy school (median, 2 [IQR, 1-3) versus 1 [IQR, 0-2]; p = 0.002). Applicants with prior work experience as a hospital pharmacy intern were also more likely than those without such experience to be offered an interview (70.0% versus 37.8% were invited, p = 0.001), as were applicants who presented a poster at a national meeting during pharmacy school (80% versus 60%, p = 0.02) or who served in a national pharmacy organization leadership position (41.4% versus 20%, p = 0.03). Pharmacy school GPA was associated with final candidate ranking; top-ranked candidates had a significantly higher median GPA than lower-ranked applicants (3.68 [IQR, 3.51-3.8] versus 3.48 [IQR, 3.23-3.7]; p = 0.003). Objective criteria within the realms of academic performance and prior work experience may be used to streamline the applicant screening process when determining candidates to invite for an on-site interview. Pharmacy school GPA was the only characteristic found to be associated with applicant final ranking.

Use of a Modified Delphi Process to Define the Leadership Characteristics Expected of Pharmacy Faculty Members

Objective. To reach a consensus on a working definition for leadership and identify expectations for leadership among all pharmacy faculty members. Methods. A modified Delphi process was employed to establish consensus among experienced department and division chairs regarding the definition and expectations of faculty leadership to guide faculty evaluation and development. From the AACP faculty roster, 280 department and division chairs were surveyed to identify participants with at least five years of experience in their roles and willingness to participate. Twenty-three chairs were identified from a variety of colleges and schools to comprise the expert panel and asked to participate in three rounds of questions over a two-month period. One Likert-type question and six open-ended questions were included in round 1. A thematic analysis of round 1 responses provided items for participants to rate their agreement with and provide comments on in rounds 2 and 3. Consensus for items was set prospectively at 80% of participants selecting agree or strongly agree for each item. Items could be modified by the panel in subsequent rounds of surveys if participants suggested edits to items. Results. Consensus was achieved among 23 chairs regarding a definition, 10 guiding principles, four learning competencies, six skills, six expected leadership activities (ELAs), and 20 personal characteristics related to faculty leadership. Conclusion. The results of this study provide guidance to pharmacy faculty members and administrators regarding leadership characteristics including knowledge, skills, and activities expected for faculty members to develop into effective leaders for the academy and the pharmacy profession.

Menopausal Symptoms and Higher Risk Opioid Prescribing in a National Sample of Women Veterans with Chronic Pain.

The greatest increases in long-term opioid use and opioid-related overdose mortality in recent years have been among women in midlife. Common menopausal symptoms broadly affect health and health care utilization in midlife, but their contribution to chronic pain management during this period is unknown. To examine relationships between menopausal symptoms and long-term opioid prescription patterns among midlife women with chronic pain. Cross-sectional analysis of national Veterans Health Administration medical and pharmacy records (2014-2015). Women Veterans aged 45-64 with ≥ 1 outpatient visit and chronic pain diagnoses spanning ≥ 90days. Long-term opioids (prescribed oral opioids for ≥ 90days), high-dose long-term opioids (> 50mg average morphine equivalent daily dose), and long-term opioids co-prescribed with central nervous system depressants (benzodiazepine and non-benzodiazepine sedative-hypnotics, gabapentin/pregabalin, muscle relaxants). Multivariable logistic regression models were used to examine associations between outcomes and menopausal symptoms (menopausal symptom-related diagnoses (i.e., "symptomatic menopausal states") on ≥ 2 encounters and/or menopausal hormone therapy, adjusting for race, age, body mass index, and mental health and substance use disorder diagnoses. In this national sample of 104,984 midlife women Veterans with chronic pain (mean age 54.5, SD 5.4years), 17% had evidence of menopausal symptoms, 51% were prescribed long-term opioids, 13% were prescribed high-dose long-term opioids, and 35% were co-prescribed long-term opioids and central nervous system depressants. In multivariable analyses, women with menopausal symptoms had increased odds of long-term opioids (OR 1.21, 95% CI 1.18-1.26), high-dose long-term opioids (OR 1.08, 95% CI 1.02-1.13), and long-term opioids co-prescribed with central nervous system depressants (sedative-hypnotics OR 1.25, 95% CI 1.22-1.30; gabapentin/pregabalin OR 1.23, 95% CI 1.20-1.27; muscle relaxants OR 1.24, 95% CI 1.20-1.28). Among midlife women Veterans with chronic pain, evidence of menopausal symptoms was associated with potentially risky long-term opioid prescription patterns, independent of known risk factors.

Menopause symptoms and chronic pain in a national sample of midlife women veterans.

Women are more likely than men to suffer chronic pain, with the highest rates seen in midlife. The symptoms that characterize menopause broadly affect health and well-being, but their contribution to chronic pain risk during this period is poorly understood. To address this gap in knowledge, we examined relationships between indicators of menopause symptoms and chronic pain among midlife women veterans, a population with prevalent chronic pain diagnoses and elevated risk for bothersome menopause symptoms. This is a cross-sectional analysis of national Veterans Health Administration medical and pharmacy records. Using national medical and pharmacy records from women veterans aged 45 to 64 with at least one VA encounter during 2014 and/or 2015 (n = 200,901), we developed multivariable logistic regression models to examine associations between menopause symptoms (defined by menopause symptom-related diagnoses on ≥2 encounters and/or menopause hormone therapy use) and chronic pain outcomes, adjusting for age, race, body mass index, mental health diagnoses, and substance use disorders. In this national sample of midlife women veterans (mean age 54.3 ± 5.4), 13% had menopause symptoms, 52% had chronic pain, and 22% had ≥2 distinct chronic pain diagnoses. In multivariable analyses, women with menopause symptoms had nearly two-fold odds of chronic pain (odds ratio 1.84, 95% confidence interval 1.79-1.90, P < 0.001) and multiple chronic pain diagnoses (odds ratio 1.79, 95% confidence interval 1.74-1.83, P < 0.001). These findings raise the possibility within this vulnerable critical period, midlife women with a higher menopause symptom burden may be most vulnerable for chronic pain.

ANALYSIS OF THE MANAGEMENT FOR GENERAL ADMINISTRATION OF PHARMACY IN GAZA STRIP BY USING SWOT ANALYSIS

Continuous change in Gaza strip due to Israeli attack and siege affects directly many sectors especially health sector and exactly the pharmaceutical one. Consequently, good management for General Administration of Pharmacy is required to avoid the decrease in medicines via analysis of strengths, weaknesses, opportunities and threats by using SWOT tool. The descriptive analysis was used by interviews with stakeholders related to General Administration of Pharmacy in Gaza strip. General Administration of Pharmacy faces a deficit in the preparation of field inspectors on pharmaceutical companies. Also the participation rates of the Civil Defence and the Ministry of Labor were reduced in joint inspection and control through committees that contribute to the control of all safety procedures and the prevention of risks. And it is difficult to export pharmaceuticals to the West Bank from Gaza factories because of division and occupation. The authors recommend a presence of clear definition of all stakeholders and responsibilities of the three parties of production (government - workers in for General Administration of Pharmacy - owners of companies, institutions and private pharmaceutical organizations). Also laboratories need to conduct hormone tests to ensure that is good for uses. The pharmaceutical system should be modernized according to international standards and indicators. The authors also recommend developing of computerized administrative system that connects the parties of production, institutions, companies and pharmaceutical warehouses. In addition to that there must be consolidation of decisions related to General Administration of Pharmacy and presence of special national strategy for pharmaceutical sector isolated from ministry of health.

Projected Prevalence of Actionable Pharmacogenetic Variants and Level A Drugs Prescribed Among US Veterans Health Administration Pharmacy Users

Implementation of pharmacogenetic testing to guide drug prescribing has potential to improve drug response and prevent adverse events. Robust data exist for more than 30 gene-drug pairs linking genotype to drug response phenotypes; however, it is unclear which pharmacogenetic tests, if implemented, would provide the greatest utility for a given patient population. To project the proportion of veterans in the US Veterans Health Administration (VHA) with actionable pharmacogenetic variants and evaluate how testing might be associated with prescribing decisions. This cross-sectional study included veterans who used national VHA pharmacy services from October 1, 2011, to September 30, 2017. Data analyses began April 26, 2018, and were completed February 6, 2019. Receipt of level A drugs based on VHA pharmacy dispensing records. Projected prevalence of actionable pharmacogenetic variants among VHA pharmacy users based on variant frequencies from the 1000 Genomes Project and veteran demographic characteristics; incident number of level A prescriptions, and proportion of new level A drug recipients projected to carry an actionable pharmacogenetic variant. During the study, 7 769 359 veterans (mean [SD] age, 58.1 [17.8] years; 7 021 504 [90.4%] men) used VHA pharmacy services. It was projected that 99% of VHA pharmacy users would carry at least 1 actionable pharmacogenetic variant. Among VHA pharmacy users, 4 259 153 (54.8%) received at least 1 level A drug with 1 188 124 (15.3%) receiving 2 drugs, and 912 189 (11.7%) receiving 3 or more drugs. The most common incident prescriptions during the study were tramadol (923 671 new recipients), simvastatin (533 928 new recipients), citalopram (266 952 new recipients), and warfarin (205 177 new recipients). Gene-drug interactions projected to have substantial clinical impacts in the VHA population include the interaction of SLCO1B1 with simvastatin (1 988 956 veterans [25.6%]), CYP2D6 with tramadol (318 544 veterans [4.1%]), and CYP2C9 or VKORC1 with warfarin (7 163 349 veterans [92.2%]). Clinically important pharmacogenetic variants are highly prevalent in the VHA population. Almost all veterans would carry an actionable variant, and more than half of the population had been exposed to a drug affected by these variants. These results suggest that pharmacogenetic testing has the potential to affect pharmacotherapy decisions for commonly prescribed outpatient medications for many veterans.

Assessment of First-Year Student Pharmacists’ Intercultural Competency Skills Using a Validated Scale and International Scenarios

Objective. To assess first-professional year student pharmacists' level of intercultural competency using international scenarios and a validated scale. Methods. The Wesleyan Intercultural Competence Scale (WICS), a validated questionnaire, was administered to student pharmacists to self-assess their intercultural skills based on their responses to various situations that students encounter in international settings. Student pharmacists rated 16 items on a 5-point Likert scale ranging from "very inaccurate" to "very accurate." Their responses allowed their intercultural competency skills to be ranked among six developmental stages. Results. The 48 participants had traveled outside of the United States an average of 2.6 times, and 34 (71%) of them spoke another language besides English. Students' average comfort level with working with culturally diverse health care students was 4.5 out of 5, and their average comfort level with working with patients of different cultures and background was 4.6 out of 5. The students' average overall score on the WICS was 21.9 out of 36, which indicated the majority of the students were in the acceptance phase of cultural competency. Conclusion. The results of this study can inform pharmacy school faculty and administrators regarding the importance of developing targeted and/or comprehensive cultural competency training for student pharmacists, in both the didactic and experiential settings, especially during global health experiences.