Pharmacy Insurance Research Articles

Deciphering the Roots of Pharmacists’ Critical Thinking About Pseudoscientific Claims: Insights from a Cross-Sectional Survey

The global trend toward self-medication has increased public reliance on over-the-counter treatments and health-related information, contributing to the spread of pseudoscientific claims in healthcare and posing serious public health risks. Pharmacists, as accessible healthcare professionals, play a crucial role in critically evaluating these claims and providing evidence-based guidance. However, little quantitative research has assessed pharmacists’ critical thinking regarding pseudoscientific claims or the factors influencing them. This study aims to evaluate the demographic factors affecting pharmacists’ critical thinking about pseudoscientific claims. A cross-sectional survey was conducted among pharmacists in hospitals, insurance pharmacies, and drugstores across Japan. The newly developed Pseudoscience Criticism Scale (PCS) measured attitudes toward pseudoscientific claims. Statistical analysis identified factors that form and influence critical thinking. This study revealed two primary dimensions: “Medical Superstitions and Unscientific Treatments” and “Natural Healing Superstitions”. Gender and educational background significantly impacted PCS scores, with male pharmacists and graduates from six-year pharmacy programs exhibiting higher skepticism. These findings underscore the importance of ongoing professional development in pharmacy education to strengthen critical thinking. The PCS is an effective tool for assessing this competency. Enhancing educational efforts is essential to equip pharmacists to effectively counter pseudoscientific claims and improve public health.

Patient awareness and practices regarding antimicrobial use and drug resistance.

Drug-resistant bacterial infections have become a substantial problem in various communities. Appropriate antimicrobial use is required because reducing antimicrobial use could reduce the number of resistant bacteria. The inappropriate use of antimicrobials can be prevented by improving the knowledge of patients, physicians, and other healthcare professionals; however, no antimicrobial awareness survey specifically aimed at patients has been conducted yet. Therefore, to promote proper antimicrobial use, mainly by patients, we conducted a survey on the attitudes of patients who brought their antimicrobial prescriptions from insurance pharmacies. The results were based on 858 responses. Awareness of the terms "bacteria, viruses, and antimicrobials" was > 80%, whereas that of "drug-resistant bacteria" was only 37.2%. Only 26.5% of respondents understood what the efficacy of antimicrobial drugs meant. Additionally, 31.5% of the respondents had experienced discontinuation antimicrobials, and approximately 70% of the reasons for discontinuation were self-judged symptom improvement. Furthermore, those who had experienced discontinuation were less aware of the various aspects of antimicrobial use than those who had not. In antimicrobial treatment, avoiding the emergence of drug-resistant bacteria is difficult, is detrimental to patients consuming treatment, and presents a major problem in society. Therefore, healthcare professionals should strive to optimize infectious disease treatment by providing appropriate guidance on the proper use of antimicrobials, significance of taking them, and harmful effects of their discontinuation to patients.

Correspondence Related to Safety Information with Information Tools Toward the Consultation from Users of Health Foods: An Exploratory Survey at Insurance Pharmacies

Correspondence Related to Safety Information with Information Tools Toward the Consultation from Users of Health Foods: An Exploratory Survey at Insurance Pharmacies

A Novel Home-Based Medication Management Program and Its Influence on Hospitalization Rates among Home Health Care Recipients

Patients do not take their medicine as prescribed 50% of the time, and of medication-related hospital admissions in the United States, 33% to 69% are due to poor medication adherence, at a cost of approximately $100 billion a year. Continue CareRx (CCRx) is a novel home-based medication management program that includes adherence packaging alongside medication reconciliation, review, and education by clinicians. We hypothesized that home health patients receiving the CCRx service may have a lower hospitalization rate than control home health patients. Between May 1, 2021, and March 31, 2023, 113 home health patients whose insurance covered the program were enrolled in CCRx. Home health patients not eligible for the program due to a noncovered pharmacy insurance benefit made up the control group (n = 21,304), which was matched with the CCRx group on age range (45-99 years old) and gender (67% women). Hospitalization rate was calculated in both groups and compared using generalized estimating equations analysis. The control group had a total of 7015 hospitalizations during the study period during 2,128,738 total managed days, whereas the CCRx group had 21 hospitalizations during 23,622 total managed days. These translated into rates of 1203 hospitalizations per 1000 per year for the control group, and 324 hospitalizations per 1000 per year for the CCRx group. The results showed that there was a significant main effect of group in predicting individual annual hospitalization rate (Wald χ2 = 56.415, P < .01). Specifically, being in the control group was associated with a 43.42-fold increase in the likelihood of a higher hospitalization rate (95% Wald CI for odds ratios: 7.24-230.44). Home health recipients enrolled in CCRx experienced a 73.1% lower hospitalization rate than controls. Making the program more widely available to patients receiving home health care may present a significant opportunity to reduce hospitalizations in this group.

Assessing the impact of the COVID-19 pandemic on newly diagnosed metastatic lung cancer healthcare resource utilization and costs in the United States.

164 Background: The COVID-19 pandemic has derailed normal operations in the healthcare delivery systems in the US and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. Methods: A retrospective claims study using de-identified medical and pharmacy insurance adjudicated claims from national and sub-national health plans and self-insured employer groups was initiated in patients greater than 18 years of age with commercial, commercial self-pay, and Medicare Advantage insurance. Analyses were conducted from January 1, 2019 to February 29, 2020, the pre-pandemic period, and compared to March 1, 2020 to April 30, 2021, the pandemic/post-pandemic period. Multivariable logistic regression models were used to assess the probability of having a hospital, ER or hospice/palliative visit. Multivariable linear regression models were used to see differences in the utilization of outpatient visits. Multivariable Generalized Linear Models with a log transformation and gamma distribution were used to see if there were differences in healthcare costs. Results: 3,230 (pre-pandemic period) and 2,922 (pandemic/post-pandemic period) patients with newly diagnosed metastatic lung cancer were included in the study. The mean age of the patients in the pre-pandemic period was 61.1 years and 61.3 years in the pandemic/post-pandemic period. The odds of receiving outpatient and inpatient hospice/palliative care, inpatient and ER care were lower in the pandemic/post-pandemic period. After controlling for all variables, (OR=0.813; 95% CI: 0.729, 0.906), p=0.0002. Per patient per month (PPPM) metastatic lung cancer-related and total costs were higher in the pandemic/post-pandemic time period. After controlling for all variables, (Cost ratio=1.059; 95% CI: 1.023, 1.096), p=0.0011. Conclusions: This is the first study assessing the impact of the COVID-19 pandemic on HCRU and costs in patients with newly diagnosed metastatic lung cancer.

Necessity for a System Implementing Therapeutic Drug Monitoring in Outpatient Settings Based on the Actual Use of Voriconazole Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan: A Descriptive Epidemiological Study.

Voriconazole (VRCZ) is an antifungal drug that necessitates therapeutic monitoring (TDM). Typically, TDM is recommended for patients undergoing long-term outpatient treatment. However, in Japan, insurance reimbursement for TDM is only permitted for inpatients. There is a concern that VRCZ use is growing among outpatients, although information regarding this issue remains unavailable. Therefore, we aimed to clarify the use of VRCZ by utilizing data from the National Database of Health Insurance Claims and Specific Health Checkups in Japan. The use of branded and generic oral VRCZ from 2013 to 2019 was calculated using the defined daily doses/1000 inhabitants/d (DID) for each receipt type. Oral VRCZ was used more frequently in the outpatient setting than that in the inpatient setting, with use increasing over time. The use of generic drugs began in 2016 and accounted for 52.5% of the use in 2019 among outpatients. Considering outpatient prescriptions, 76.4-81.0% were dispensed at insurance pharmacies, indicating the need for community pharmacist involvement. Accordingly, the appropriate use of VRCZ in ambulatory care should be promoted in collaboration with community pharmacists, and a reimbursement system should be established to implement TDM in ambulatory care.

Effect of a Family Pharmacist System on Medication Adherence of Patients with Dyslipidemia during a COVID-19 Epidemic

The pharmacy pharmacist's function as a family pharmacist is expected to improve adherence to medication in patients suffering from chronic diseases, including dyslipidemia. This is true even in infectious disease epidemics. In this study, using anonymously processed receipt data from 700 insurance pharmacies in our group, we evaluated medication adherence in patients taking statin drugs before, during the first and second years of coronavirus disease 2019 (COVID-19) epidemic in terms of medication persistence and medication possession, and compared the results between the family pharmacist group (FP group) and non-family pharmacist group (NoFP group). The odds ratios of good medication adherence (medication persistence and medication possession) rates for the FP group relative to the NoFP group were 1.446 [95% confidence interval (CI): 1.210-1.727] in the pre-epidemic period, 1.428 (1.192-1.710) in the first year of the epidemic, and 1.270 (1.113-1.450) in the second year of the epidemic. The FP group was significantly higher in all time periods. Therefore, it is suggested that the family pharmacist function improves adherence to statins not only before but also during the COVID-19 epidemic.

Metabolic Acidosis and Adverse Outcomes and Costs in CKD: An Observational Cohort Study

Metabolic acidosis is a risk factor for progression of chronic kidney disease (CKD), but little is known about its effect on health care costs and resource utilization. We describe the associations between metabolic acidosis, adverse kidney outcomes, and health care costs inpatients with CKD stages G3-G5 and not receiving dialysis. Retrospective cohort study. An integrated claims-clinical data set of US patients with CKD stages G3-G5, with serum bicarbonate values of 12 to<22 mEq/L (metabolic acidosis group) or 22 to 29 mEq/L (normal serum bicarbonate level group). The primary exposure variable was the baseline serum bicarbonate level. The primary clinical outcome was the composite of all-cause mortality, maintenance dialysis, kidney transplant, or a decline in the estimated glomerular filtration rate of≥40% (DD40). The primary cost outcome was all-cause predicted per-patient per-year cost, assessed over a 2-year outcome period. Logistic and generalized linear regression models, adjusted for key covariates such as age, sex, race, kidney function, comorbidities, and pharmacy insurance coverage, were used to assess serum bicarbonate levels as a predictor of DD40 and health care costs, respectively. 51,558 patients qualified. The metabolic acidosis group experienced higher rates of DD40 (48.3% vs. 16.7%, P<0.001) and higher all-cause yearly costs ($65,172 vs. $24,681, P<0.001). Two-year adjusted odds ratio of DD40 per 1-mEq/L increase in serum bicarbonate levels was 0.873 (95% CI, 0.866-0.879); the parameter estimate (±SE) for costs was-0.070±0.0075 (P<0.001). Possible residual confounding. Patients with CKD and metabolic acidosis had higher costs and rates of adverse kidney outcomes compared with patients with normal serum bicarbonate levels. Each 1-mEq/L increase in serum bicarbonate levels was associated with a 13% decrease in 2-year DD40 events and a 7% decrease in per-patient per-year cost.

Measuring Response to Adjunctive Therapy Among Individuals with Major Depressive Disorder.

Incomplete or inadequate response to first-line antidepressant therapy (ADT) for major depressive disorder (MDD) is common. Response to adjunctive therapy is less understood. To estimate response to adjunctive pharmacotherapy or psychotherapy among individuals with MDD on an antidepressant using the PHQ-9 questionnaire. This was a retrospective cohort analysis using medical and pharmacy insurance claims among individuals with MDD or ADT who initiated adjunctive pharmacotherapy, psychotherapy, or both (dual). Eligible individuals initiated adjunctive therapy between 7/1/2014-12/31/2018. Symptom severity was measured by PHQ-9 score in the 6-month baseline and 12-month follow up. Multivariate logistic regression identified factors associated with improved symptom severity. Most (81.8%) of the 2389 participants initiated adjunctive pharmacotherapy, followed by psychotherapy (12.7%) and dual adjunctive (5.5%). Only 30.2% had both a baseline and follow-up PHQ-9 score. Among those with mild or more severe PHQ-9 baseline scores, 36.7% had the same or worse MDD severity during follow-up. Among those with moderate or more severe baseline scores, 28.1% had the same or worse MDD severity during follow-up. Most individuals with moderate-to-severe MDD did not receive a follow-up questionnaire, suggesting incomplete monitoring of treatment response. Among those with a PHQ-9 following initiation of adjunctive therapy, many continued to report impactful symptoms. Future studies should explore alternate treatment approaches and methods to support the utilization of the PHQ-9 for monitoring treatment response.

Association between PM2.5 and daily pharmacy visit tendency in China: A time series analysis using mobile phone cellular signaling data

While much is known about the effects of PM2.5 pollution on severe health outcomes, less is known about the heterogeneous impacts of air pollution on less severe health effects experienced by large numbers of people, such as those resulting in pharmacy visits. Based on anonymized daily pharmacy visits extracted from about 136,000 mobile phone station macrocells and 28,170 pharmacy locations, we used the generalized additive model and meta-analysis to investigate the effects of PM2.5 exposure on pharmacy visit tendencies (PVTs), as a proxy variable of health facility utilization, across regions, groups and social contexts. Overall, PVTs increased by 0.338% (95% CI: 0.335%–0.342%) for per 10 μg/m3 increases in PM2.5. The exposure-response curve was nonlinear, having a sharp slope below 60 μg/m3 and then flattening. Sensitivity analyses showed that results were robust to modeling choices and existence of noise in captured PVT data. At pharmacy level, higher percentage increases in PVTs were observed in near-residency pharmacies (0.474%), designated medical insurance pharmacies (0.360%), and pharmacies in urban areas (0.457%) than their counterparts (0.156%, 0.321%, 0.180%). This indicates that social contexts, including inconvenient access to the pharmacy and limited social medical insurance coverage, inhibited residents from utilizing health facilities for the health care needed. Interactions of social contexts led to strong heterogeneity among cities, between rural and urban regions as well as across communities, which call for differentiated health resources allocations to ensure health equity.

A Comparison for Time for Drug Administration Guidance and Patient’s Pharmacy Stay between Anti-influenza Drugs in Insurance Pharmacies

A Comparison for Time for Drug Administration Guidance and Patient’s Pharmacy Stay between Anti-influenza Drugs in Insurance Pharmacies

Status of Inquiries to Prescribing Doctors about Cancer Chemotherapy Prescriptions by Pharmacists at an Insurance Pharmacy

Status of Inquiries to Prescribing Doctors about Cancer Chemotherapy Prescriptions by Pharmacists at an Insurance Pharmacy

Survey on Medication Methods for Patients Undergoing Tube Feeding in Insurance Pharmacies

Survey on Medication Methods for Patients Undergoing Tube Feeding in Insurance Pharmacies

A Survey on Multiple Medication Using the Insurance Pharmacy Dispensing Database: A Study on Elderly Patients Covered through STOPP-J

A Survey on Multiple Medication Using the Insurance Pharmacy Dispensing Database: A Study on Elderly Patients Covered through STOPP-J

Efforts of Health Insurance Pharmacies That Have Begun Accepting Prescriptions of Blood Coagulation Factor Products: Qualitative Analysis Using a Modified-grounded Theory Approach

Efforts of Health Insurance Pharmacies That Have Begun Accepting Prescriptions of Blood Coagulation Factor Products: Qualitative Analysis Using a Modified-grounded Theory Approach

Improving Organizational Sustainability of an Urban Indian Health Clinic With an Innovative Pharmacy Model.

Introduction:To increase access to care for the urban American Indian population, a collaboration was developed between an Urban Indian Health Clinic (UIHC) and Federally Qualified Healthcare Center (FQHC) to reduce financial barriers, increase patient access to affordable medications, and augment the integrated model of care.Objective:To describe the design and implementation of an innovative pharmacy model through a partnership between an UIHC and a FQHC.Methods:A collaborative partnership between an UIHC and a FQHC was developed to spread scarce 340B federal resources as a method to enhance patient care. The innovative practice model included the development of processes to (1) increase medication access to all patients by providing access to affordable medications at clinic and the provision of mail order services, (2) minimize program expenses through cost-sharing of a pharmacist salary, (3) expand clinical pharmacy programs (collaborative drug therapy management) to augment integrated patient care, and (4) optimize 340B cost savings for the clinic by establishing contracts and implementing adjudication software to obtain medication reimbursement from Medicaid and other third party insurances.Results:Through the cost-sharing of a pharmacist salary and use of remote verification, the majority of prescription medications were available to patients at the UIHC through implementation and expansion of an other outlet. Collaborative drug therapy management (CDTM) protocols were successfully implemented which allowed clinical pharmacy services to collaboratively manage chronic conditions. All adult primary care providers adopted the integrated patient care model. Third-party pharmacy insurance contracts were obtained and computer software was installed to allow for the adjudication of pharmacy claims, resulting in cost savings from medication reimbursement.Conclusion:The innovative collaborative partnership between an UIHC and an FQHC demonstrated how scarce federal resources can be leveraged using the 340B program to increase patient access to affordable medications. This innovative model reduced financial barriers to the clinic, and allowed for expansion of pharmacist led CDTM programs and augmentation of integrated clinical services. The cost savings observed from this novel program additionally fueled programmatic sustainability through reinvestment into the pharmacy program and is expected to continue to fund the program in the future.

Migraine Characteristics, Comorbidities, Healthcare Resource Utilization, and Associated Costs of Early Users of Erenumab in the USA: A Retrospective Cohort Study Using Administrative Claims Data.

IntroductionErenumab is indicated for migraine preventive treatment in adults. The objective of this study was to provide descriptive information on real-world use of erenumab including patient profile and treatment patterns.MethodsWe completed a retrospective review of US data (through May 2019) from the IBM MarketScan® Early View Databases, identifying adult patients newly treated with erenumab with a migraine claim in the year prior to first erenumab claim (index) and at least 1 year of continuous pre-index medical and pharmacy insurance coverage, to assess pre- and post-erenumab migraine characteristics, comorbidities, healthcare resource utilization, and associated costs. All data were summarized using descriptive statistics.ResultsA total of 9753 patients met inclusion criteria. The average (SD) age was 46 (12) years, 85% of patients were female, and 64% had at least one claim for chronic migraine; 70% of erenumab users had an initial dose of 70 mg; 77% of patients in the 6-month follow-up sample (n = 4437) remained on their initial erenumab dose. Persistence at 6-month follow-up was 47.3% with a mean (95% CI) proportion of days covered of 0.68 (0.67, 0.68). In the post-erenumab period, claims for comorbidities of non-migraine headaches and anxiety were reduced and there was a shift to decreased use of acute and preventive medications. Reductions in overall use and associated cost of healthcare resources such as inpatient hospitalization and outpatient office visits were minimal, with slightly more pronounced reductions in the subgroup of patients that were persistent to erenumab.ConclusionsWe observed reductions in claims for important migraine characteristics, comorbidities, and a shift to decreased use of acute and preventive migraine medications—observations indicative of the real-world effectiveness of erenumab. Further examination is required as persistence to erenumab, which may be influenced by dose titration, appears to be an important factor in changes to healthcare resource utilization and costs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00319-z.

Utility of the Family Pharmacist System:

This retrospective cohort study aimed to evaluate the utility of the family pharmacist system using administrative claims data. The eligible cohort was detected from the JMDC claims database; it was divided into two groups-those using the system (users) and those not using the system but receiving general pharmaceutical management (non-users) in health insurance pharmacies. The calculation of chouhukutouyaku-sougosayoutou-boushi-kasan-which consisted of the calculation other than the adjustment of leftover drugs and the calculation related to the adjustment of leftover drugs-was considered an indicator of the system’s utility. This indicator was compared between the two groups from April 2018 to March 2020, and a generalized linear model (link, identity; distribution, binomial) was developed to estimate the adjusted absolute risk differences (ARDs) and 95％ confidence intervals (CIs). A total of 162,340 patients were included in the eligible cohort (users [n = 1,214]; non-users [n = 161,126]). Chouhukutouyaku-sougosayoutou-boushi-kasan was examined among 177 participants (14.6％) of users and 9,052 (5.6％) of non-users (adjusted ARD, 5.1; 95％ CI, 3.2 to 7.1). Furthermore, the adjusted ARD was 3.1 (95％ CI, 1.6 to 4.7) and 2.4 (95％ CI, 1.0 to 3.7), for the calculation other than the adjustment of leftover drugs and the calculation related to the adjustment of leftover drugs, respectively. The current study reported that the family pharmacist system was related to the increase in the calculation of chouhukutouyaku-sougosayoutou-boushi-kasan. Therefore, it is suggested that the system was useful for facilitating pharmaceutical management in health insurance pharmacies.

A Study of the Actual Conditions of Registered Dietitians and Dietitians Working in Insurance Pharmacies and Drugstores

A Study of the Actual Conditions of Registered Dietitians and Dietitians Working in Insurance Pharmacies and Drugstores

保険薬局における健康食品・サプリメントと医薬品の相互作用に関するナチュラルメディシン・データベースを用いた実態調査

保険薬局における健康食品・サプリメントと医薬品の相互作用に関するナチュラルメディシン・データベースを用いた実態調査