Pharmacy Quality Research Articles

AACP’s Strategic Commitment to Improving Pharmacy Education: Past, Present, and Future

Since its founding in 1900, the American Association of Colleges of Pharmacy (AACP) has been focused on quality pharmacy education. As the Association and its institutional and individual members now consider contemporary issues in education, such as competency-based education, it is important to continue their collective work in the context of AACP’s enduring mission: to advance pharmacy education, research, scholarship, practice, and service, in partnership with members and stakeholders, to improve health for all. While language, labels, and strategies evolve over time and across significant changes in social, economic, political, and health care environments, AACP’s commitment to quality in education has been and must continue to be unwavering. Constraints and challenges perceived in the short term should not deter deliberate and strategic quality improvement efforts over time and in the longer term. AACP’s 2021–2024 Strategic Plan, entitled Preparing Pharmacists and the Academy to Thrive in Challenging Times, acknowledges the need to prepare pharmacists for seemingly constant change in the health care environment.

Best practices for supporting and improving pharmacy resident research and quality improvement projects

AbstractThe 2023 ACCP Research Affairs Committee was charged with developing a commentary to address best practices in pharmacy resident research and quality improvement projects and to consider methods to overcome the challenges encountered in conducting these projects. Literature regarding best practices was evaluated, and approaches were recommended that might help (1) advance the value of the projects to stakeholders; (2) overcome limited preparation for research by residents and mentors, including writing skills and dissemination experience; (3) overcome challenges related to resources (e.g., time and mentors); and (4) avoid burnout among residents and mentors. Although there are many challenges to completing projects and disseminating the results, studies have provided useful recommendations to help circumvent the barriers.

Determinants t of patient satisfaction with pharmacy services at Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia

Background: Patients have explicit desire for quality services when they visit health institutions. Patient satisfaction is a primary means of measuring the effectiveness of healthcare delivery. However, inadequate discovery of their needs may result in patient dissatisfaction. Patients who are satisfied with pharmaceutical care are likely to adherence, seeking for medical attentions and take medications properly. Providing better access to quality pharmacies is a way to improve patient satisfaction with healthcare services. Study objective: The study was aimed to assess patient satisfaction with pharmacy services at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). Methods and materials: An institution-based cross-sectional study design was conducted at FHCSH from 1 May 2021 to 30 October 2021. Data were collected by interview with structured questionnaires. Then the data were coded, entered, and then analyzed by SPSS version 23. The association between predictors and outcome was measured using bivariate logistic regression. Result: In this study, 384 study participants were included. Majority of the participants were males (55.37%, N=227). The overall satisfaction score of the participants of this study was 65.37%. In our study, clients showed greater satisfaction towards pharmacists’ commitment to correct myths (92%), pharmacist availability (88.78), and cleanliness (87.8%). Multivariate analysis indicated physical restriction [adjusted odds ratio (AOR)=6:95%; 95% CI (2.98, 25.9)] and rural residence [AOR=2.43; 95% CI (1.71, 9.6)] had significant association with pharmacy service dissatisfaction. Among the quality pharmacy service indicators, counselling on how medications work [AOR=9; 95% CI (1.48, 8.85)], keeping to dosage regimen [AOR=7.3; 95% CI (5.49, 11.06)], and advice on the current medical condition had greater odds of client dissatisfaction. Conclusion: The findings of the current study showed that patients’ satisfaction towards outpatient pharmacy services provided by FHCSH is very low as it is indicated in their perception towards revealing written information about medication use, medication availability, medication storage, and instructions about medication side effects.

Can a self-inspection programme improve compliance with professional standards in a hospital pharmacy?

Abstract Introduction Pharmacies must comply with professional standards to provide high-quality services. However, gaining assurance of compliance can be challenging and self-inspection was investigated as a means of consistently achieving this. Aim This project aimed to develop and implement a self-inspection programme to assess compliance with professional standards in a hospital pharmacy. Through the self-inspections, we aimed to identify required improvements and maintain achieved compliance through effective reporting, evaluation, and communication of results. Methods Standards from Royal Pharmaceutical Society professional guidance1, standards2 and General Pharmaceutical Council standards3 were used to create 41 self-inspection questions. These assessed different aspects of medicines management, including the receipt, storage, dispensing, delivery, disposal, and security of medicines. They also assessed compliance with health and safety measures and service quality indicators taken from the monthly quality report, health and safety report, cleaning logs, expiry date checks and stock checks in the department. Self-inspections were conducted monthly over a 12-month period by members of the Pharmacy Senior Leadership Team. Self-inspections were recorded using the Tendable accreditation application. Training in using the application and a standard operating procedure was in place to support this. Questions in the self-inspection were only answered as “Yes” or “No”. Additional information, images or actions taken were required for any question that was negatively scored. Following self-inspections, results were calculated by the application and a summary generated. A full report was also produced by the application. These were analysed by the Pharmacy Quality Assurance Team and included in the monthly departmental quality report for review by the Pharmacy Senior Leadership Team. Any identified actions were communicated by e-mail to the relevant team leader and an inspection summary later displayed in the department. This study did not require ethics approval. Results Compliance with standards increased steadily from 75% on the first self-inspection to 95%, with an average of 89% over the 12 months. During the self-inspections, non-compliance with 14 different standards was identified. 3 concerned non-compliance of staff with processes, which was addressed and not repeated. 11 concerned non-compliance that was repeated, including delays in updating essential documents, delays in completing essential tasks, medicines storage not complying with requirements, a correct responsible pharmacist notice not displayed and building work disrupting services. All of these have now been resolved, except deficiencies in the storage of bulk fluids, where risks have been mitigated and a long-term plan is in place. Discussion/Conclusion Compliance with professional standards in the pharmacy has been improved through the implementation of a self-inspection programme. Questions in the self-inspection defined the required standards and guidance on conducting self-inspections ensured consistent assessment, enabling both compliance and non-compliance to be identified. Processes for reporting, evaluating and communicating results from the self-inspections directed how non-compliance was resolved. This promoted awareness of required standards and helped maintain achieved compliance. Limitations of the study included failing to assess compliance with standards not covered in the self-inspection questions. A regular review of self-inspection questions, standards and results is therefore required to maintain reliability and continued improvement.

Patterns of prescription opioid use and opioid-related harms among adult patients with hematologic malignancies.

Treatment advances for hematologic malignancies (HM) have dramatically improved life expectancy, necessitating greater focus on long-term cancer pain management. This study explored real-world patterns of opioid use among patients with HM. This retrospective cohort study identified adults diagnosed with HM from January 1, 2013 through December 31, 2019 using the Truven MarketScan Commercial Claims and Encounters database. Across several HM types, we described rates of high-risk opioid use (based on Pharmacy Quality Alliance measures) and opioid-related harms, including incident opioid use disorder (OUD) diagnoses and opioid-related hospitalizations or emergency department (ED) visits. We used multivariable Cox regression to generate adjusted hazard ratios and 95% confidence intervals comparing the risk of opioid-related harms between patients with versus without high-risk opioid use. Our sample included 43,190 patients with HM. Median age at HM diagnosis was 54 years (interquartile range = 44-60). Most patients (61.9%) were diagnosed with lymphoma. Approximately half (49.2%) had an opioid dispensed in the follow-up period. Among all patients, 20.0% met criteria for high-risk opioid use, 0.9% had an OUD diagnosis, and 0.3% experienced an opioid-related hospitalization/ED visit in follow-up. High-risk opioid use increased the risk of an OUD diagnosis by 3.3 times (p < 0.0001) and an opioid-related hospitalization/ED visit 4.2 times (p < 0.0001). High-risk opioid use was prevalent among patients with HM and significantly increased the risk of opioid-related harms. However, rates of opioid-related harms were low. These findings highlight the importance of continually monitoring pain and opioid use throughout HM survivorship to provide safe, effective HM pain management.

Managing the COVID-19 health crisis: a survey of Swiss hospital pharmacies

BackgroundThe COVID-19 pandemic strained healthcare systems immensely as of 2020. Switzerland’s hospital pharmacies’ responses during the first wave were surveyed with a view to improving the quality of pharmaceutical management in future health crises.MethodsAn online survey was sent to the heads of all of Switzerland’s hospital pharmacies. The questionnaire was organised into eleven sections of questions covering many topics regarding the management of COVID-19’s first wave. Data collection occurred from May to June 2020.ResultsAnalyses were performed using the 43 questionnaires (66%), with at least one answer per questionnaire, out of 65 distributed. Seventeen of 41 pharmacies responding (41%) had existing standard operating procedures or pandemic plans and 95% of these (39/41) set up crisis management steering committees. Twenty-nine of 43 pharmacies responding (67%) created new activities to respond to the pandemic’s specific needs. Twenty-six of 39 pharmacies responding (67%) created new drug lists for: COVID-19-specific treatments (85%; 22/26), sedatives (81%; 21/26), anaesthetics (77%; 20/26) and antibiotics (73%; 19/26). Drug availability in designated COVID-19 wards was managed by increasing existing stocks (54%; 22/41 pharmacies) and creating extra storage space (51%; 21/41). Two drugs generated the greatest concern about shortages: propofol (49%; 19/39 pharmacies) and midazolam (44%; 17/39). Remdesivir stocks ran out in 26% of pharmacies (10/39). Twelve of 43 pharmacies (28%) drafted specific new documents to respond to medical needs regarding drug administration, 12 (28%) did so for drug preparation and 10 (23%) did so for treatment choices.ConclusionsSwitzerland’s hospital pharmacies encountered many challenges related to the COVID-19 crisis and had to find solutions quickly, effectively and safely. The survey highlighted the key role that hospital pharmacies played in many aspects of the pandemic by providing logistical and clinical support to medical and nursing care teams. The lessons and experiences outlined could be used to improve the quality of hospital pharmacies’ readiness for similar future events.

Product development and quality of pharmacy compounded chenodeoxycholic acid capsules for Dutch cerebrotendinous xanthomatosis patients.

Introduction: In 2017 the drug chenodeoxycholic acid (CDCA) became unavailable to Dutch patients with the rare inborn error of metabolism cerebrotendinous xanthomatosis (CTX). This was a direct result of a steep price increase after CDCA was authorized in the EU as an orphan drug. As a result, Dutch health insurance companies were unable to reimburse this drug and the availability of CDCA to patients with CTX was directly at risk creating an unmet medical need. CTX is characterized by juvenile cataract, tendon xanthomas, infantile-onset diarrhea, psychomotor retardation and progressive cerebellar ataxia. Treatment with CDCA, when initiated before neurological symptoms are present, can prevent the onset of neurological complications. Methods: To assure continuation of patient treatment with a high quality product, the hospital pharmacy of the Amsterdam UMC developed CDCA capsules as a pharmacy preparation. A simple and robust formulation was developed for capsules in a broad dose range of 35-250mg, ensuring that both pediatric and adult patients can receive an exact dose tailored to their specific needs. Capsules are prepared manually on a small scale for the individual patient. To assure the quality of the product, product validation and stability studies were performed. Results: The results show that the product complies with all specifications based on the requirements of the European Pharmacopoeia. The capsules contain the declared amount of CDCA, no degradation product or other (microbiological) impurities are formed during the production process and the capsules show a quick dissolution profile. Stability studies indicate that it is a stable product and no impurities increase or arise over time. These results show that these pharmacy preparations are of high quality and comply to Good Manufacturing Practice (GMP) requirements. Discussion: Through our research, we have demonstrated that pharmacy compounding can be a viable alternative in situations where immediate access to essential medication is crucial or when certain drugs are temporarily inaccessible. The purpose of this paper is to offer comprehensive guidance to other pharmacies to improve the availability of currently inaccessible drugs through the practice of pharmacy compounding, thereby facilitating improved patient care.

Responding to Urinary Tract Infection Symptoms in England's Community Pharmacies.

Most urinary tract infections (UTIs) are self-limiting and frequently present in primary care; it is common for patients to seek symptom relief. The TARGET Treating Your Infection (TYI) leaflet was used to respond to UTI symptoms for women under 65 years presenting in community pharmacies. The widespread use of these leaflets was incentivised as part of NHS England's Pharmacy Quality Scheme (PQS) 2022-23, between October 2022 and March 2023. The TARGET TYI leaflets are aimed to support appropriate antibiotic use and antimicrobial stewardship (AMS) as well as reducing the opportunity for resistance to develop. A total of 8363 community pharmacies completed the AMS criteria within the PQS and collectively submitted data for 104,142 patients presenting with UTI symptoms. The majority, 77% (75,071), of (non-pregnant) women presented with none or only one of the three strongly predictive symptoms of dysuria, new nocturia, cloudy urine, and/or vaginal discharge and, therefore, were less likely to have a UTI, as outlined in the English UTI diagnostic guidance. Conversely, 23% (22,381) of women presented with two or more symptoms of dysuria, new nocturia, cloudy urine, and with no vaginal discharge and, therefore, they were more likely to have a UTI. The TARGET TYI UTI leaflets support community pharmacy teams to differentiate between symptoms more likely to be associated with UTIs and those that could be managed with self-care. The findings suggest that most women presenting to community pharmacies with urinary symptoms were likely to have self-limiting symptoms, and could be suitably managed with self-care, pain relief, and appropriate safety netting. Approximately one-third of patients were managed by community pharmacy team members without the need for referral to a pharmacist and one in five patients presented with escalation symptoms and were signposted to other healthcare settings. A total of 94% (97,452) of women received self-care advice of which 36% (37,565) were also provided with additional patient information leaflets.

Impact of Pharmacist-Led PDCA Cycle in Reducing Prescription Abandonment: An Action Research from China.

Taking medicine as prescribed in time plays an important role in the treatment of diseases. However, some prescriptions have not picked up in time for various reasons. To analyze the influencing factors in patients with prescription abandonment and the role of pharmacists in Plan-Do--Check-Act (PDCA) cycle, we conducted a study in our hospital of Hangzhou, China. Based on the prescription abandonment from October 1, 2021 to March 31 2022, we collected and analyzed the possible causes. According to the PDCA management method, we conducted improvement measures and supervised the implementation of measures from April 1, 2022 to September 30, 2022. The number, the proportion and the amount of prescription abandonment before and after establishment of the PDCA cycle were analyzed. Three measures were proposed and applied to improve the prescription abandonment:(I) Enhancing the education and training to the staff. (II) Improving the medical environment for patients, especially the environment for taking medicine. (III) Updating the computer information software. After the implementation of PDCA, the number of prescription abandonment decreased from 2030 to 775, there was significant reduction in the proportion of prescription abandonment (4.75‰ vs 1.77‰, P<0.05), and the amount of prescription abandonment decreased from $36,161.11 to $17,041.59. The target compliance rate was 108.36%. The implementation of pharmacist-led PDCA can effectively reduce the number, the proportion and the amount of prescription abandonment, Moreover, Pharmacists play an important role in improving the management quality of outpatient pharmacy, and PDCA is a feasible and effective management tool for reducing prescription abandonment.

Longitudinal Introductory Pharmacy Practice Experience and Quality Improvement: Innovation and Impact

Longitudinal Introductory Pharmacy Practice Experience and Quality Improvement: Innovation and Impact

Sleep quality of academics from health courses at UNEC - Nanuque Campus (MG)

Introduction: A high number of students linked to the health area have been related to problems with poor sleep quality, raising an alert about the need to promote programs to improve the duration and quality of the night rest hours of pharmacy, nursing and physiotherapy students. Objective: To analyze the sleep quality of Nursing, Pharmacy and Physiotherapy students enrolled in the night shift of UNEC - Nanuque Campus. Methodology: The present research went through the theoretical assumptions of a quantitative research, of exploratory and descriptive character, in which it sought in an educational institution, the perceptions of 70 students enrolled in UNEC - Nanuque Campus, through a questionnaire containing 10 structured questions. Results: About 95% of respondents sleep after 23 hours, 72% take more than half an hour to sleep, 74% sleep less than recommended by the medical association, 51% rate the quality of and 70% said they have already ingested medicine to induce sleep. Conclusion: The picture of few hours of sleep, justified the excessive use of self-medication and the search for sleeping pills, something worrying because using medications on their own can be harmful to the students' bodies.

Solving racial/ethnic disparities associated with Medicare Part D Star Ratings

Objective Medicare Part D Star Ratings are instrumental in shaping healthcare quality improvement efforts. However, the calculation metrics for medication performance measures for this program have been associated with racial/ethnic disparities. In this study, we aimed to explore whether an alternative program, named Star Plus by us that included all medication performance measures developed by Pharmacy Quality Alliance and applicable to our study population, would reduce such disparities among Medicare beneficiaries with diabetes, hypertension, and/or hyperlipidemia. Method We conducted an analysis of a 10% random sample of Medicare A/B/D claims linked to the Area Health Resources File. Multivariate logistic regressions with minority dummy variables were used to examine racial/ethnic disparities in measure calculations of Star Ratings and Star Plus, respectively. Results Adjusted results indicated that relative to non-Hispanic Whites (Whites), racial/ethnic minorities had significantly lower odds of being included in the Star Ratings measure calculations: the odds ratios (ORs) for Blacks, Hispanics, Asians, and Others were 0.68 (95% confidence interval [CI] = 0.66–0.71), 0.73 (CI = 0.69–0.78), 0.88 (CI = 0.82–0.93), and 0.92 (CI = 0.88–0.97), respectively. In contrast, every beneficiary in the sample was included in Star Plus. Further, racial/ethnic minorities had significantly higher increase in the odds of being included in measure calculation in Star Plus than Star Ratings. The ORs for Blacks, Hispanics, Asians, and Others were 1.47 (CI = 1.41–1.52), 1.37 (CI = 1.29–1.45), 1.14 (CI = 1.07–1.22), and 1.09 (CI = 1.03–1.14), respectively. Conclusions Our study demonstrated that racial/ethnic disparities may be eliminated by including additional medication performance measures to Star Ratings.

It is time for a new comprehensive medication review quality measure.

Medication therapy management (MTM) services include comprehensive medication reviews (CMRs), which have been completed with millions of patients since their inception in the United States. The current MTM quality measure focuses on whether CMRs were completed (ie, the CMR completion rate). However, this process measure does not assess quality of care, or patient-reported or other outcomes of CMRs, and, therefore, does not reward MTM providers for improving health outcomes. In this viewpoint article, we present 3 reasons that shape our argument for new MTM quality measures and offer recommendations on next steps to achieve this. DISCLOSURES: Dr Vaffis is an employee of Clinical Outcomes Solutions and discloses this was work was completed previously during her employment at the University of Arizona. Dr Dhatt is an employee of Janssen and discloses this was work was completed previously during her employment at the University of Arizona. Dr Anderson is an employee of The Freedom Fund and discloses this was work was completed previously during her employment at the University of Arizona. Dr Black is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Dr Campbell received funding from Pharmacy Quality Alliance, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and SinfoniaRx and discloses this work was completed previously during his employment at the University of Arizona. Dr Kolobova is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Dr Hines is an employee of Pharmacy Quality Alliance. Dr Castora-Binkley is an employee of Pharmacy Quality Alliance. Dr Nelson is an employee of Pharmacy Quality Alliance. Dr Axon received funding from Pharmacy Quality Alliance, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and SinfoniaRx. Dr Warholak received funding from Pharmacy Quality Alliance, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and SinfoniaRx and discloses this was work was completed previously during her employment at the University of Arizona.

Service Quality Assessment of Retail Pharmacies in Balingasag, Misamis Oriental Based on Hybrid AHP-RSQ Model

The number of retail pharmacies in Balingasag, Misamis Oriental have increased due to the promising economic development of the municipality. Despite customers having wide alternative options to choose, service quality-implementation by respective pharmacies have perhaps executed inconsistently leading to a poor outlook of the stores service. The main objective of this study is to assess the service quality and performance efficiency of pharmacies surrounding the central area of the municipality of Balingasag using Analytical Hierarchy Process (AHP). We discuss in this paper the analysis of criterion prioritization through expert judgments, identify retail pharmacies with high and low performance efficiency of service quality. Criteria considered in formulating the AHP architecture is based on the retail service quality scale of Dabholkar et al. (1996) including workplace hygiene, understanding, accessibility, reliability, guidance, policy, and problem – solving. Based on experts’ judgments using pairwise comparison, different performance indicators have been evaluated: the most prioritized criterion among the seven (7) criteria is ‘problem-solving’ with a criterion weight of 0.22 while the least prioritized criterion is ‘accessibility’ with a criterion weight of 0.05. Empirical evaluation integrated with the obtained criterion weights showed that among ten (10) retail pharmacies; nine (9) pharmacies have good performance quality, while the remaining pharmacy have an acceptable performance in service quality implementation. The result of this study gives emphasis that ‘problem-solving’ criterion in the implementation of service quality should be strengthened by retail pharmacies to subsequently improve its service quality performance and competitive positioning.

The National Implementation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI) through the English Pharmacy Quality Scheme 2020 to 2022.

Since 2020, England's Pharmacy Quality Scheme (PQS) has incentivised increased antimicrobial stewardship (AMS) activities in community pharmacy. In 2020/21, this included the requirement for staff to complete an AMS e-Learning module, pledge to be an Antibiotic Guardian and develop an AMS Action plan. To build and embed these initiatives, in 2021/22, the PQS required the use of the TARGET Antibiotic Checklist (an AMS tool for use when patients present with a prescription for antibiotics to support conducting and recording of a series of safety and appropriateness checks against each prescribed antibiotic). This paper describes the implementation of the national PQS criteria from 2020 to 2022, and details community pharmacies' AMS activities and barriers to implementation of the 2021/22 criteria. A total of 8374 community pharmacies submitted data collected using the TARGET Antibiotic Checklist for 213,105 prescriptions; 44% surpassed the required number for the PQS. Pharmacy teams reported checking the following: duration, dose, and appropriateness of antibiotics; patient allergies and medicine interactions (94-95%); antibiotic prescribing guideline adherence (89%); and the patient's previous use of antibiotics (81%). The prescriber was contacted for 1.3% of TARGET Antibiotic Checklists (2741), and the most common reasons for such contacts were related to dose, duration, and possible patient allergy. A total of 105 pharmacy staff responded to a follow-up questionnaire, which suggested that some AMS principles had been embedded into daily practice; however, the necessary time commitment was a barrier. The PQS was able to incentivise mass AMS activities at pace over consecutive years for England's community pharmacies simultaneously. Future research should monitor the continuation of activities and the wider impacts on primary care.

Impact of an Area Agency on Aging pharmacist-led Community Care Transition Initiative

BackgroundRural older adults are at risk of readmissions and medication-related problems after hospital discharge. ObjectivesThis study aimed to compare 30-day hospital readmissions between participants and nonparticipants and describe medication therapy problems (MTPs) and barriers to care, self-management, and social needs among participants. Practice descriptionThe Michigan Region VII Area Agency on Aging (AAA) Community Care Transition Initiative (CCTI) for rural older adults after hospitalization. Practice innovationEligible AAA CCTI participants were identified by an AAA community health worker (CHW) trained as a pharmacy technician. Eligibility criteria were Medicare insurance; diagnoses at risk of readmission; length of stay, acuity of admission, comorbidities, and emergency department visits score more than 4; and discharge to home from January 2018 to December 2019. The AAA CCTI included a CHW home visit, telehealth pharmacist comprehensive medication review (CMR), and follow-up for up to 1 year. Evaluation methodsA retrospective cohort study examined the primary outcomes of 30-day hospital readmissions and MTPs, categorized by the Pharmacy Quality Alliance MTP Framework. Primary care provider (PCP) visit completion, barriers to self-management, health, and social needs were collected. Descriptive statistics, Mann-Whitney U, and chi-square analyses were used. ResultsOf 825 eligible discharges, 477 (57.8%) enrolled in the AAA CCTI; differences in 30-day readmissions between participants and nonparticipants were not statistically significant (11.5% vs. 16.1%, P = 0.07). More than one-third of participants (34.6%) completed their PCP visit within 7 days. MTPs were identified in 76.1% of the pharmacist visits (mean MTP 2.1 [SD 1.4]). Adherence (38.2%) and safety-related (32.0%) MTPs were common. Physical health and financial issues were barriers to self-management. ConclusionAAA CCTI participants did not have lower hospital readmission rates. The AAA CCTI identified and addressed barriers to self-management and MTPs in participants after the care transition home. Community-based, patient-centered strategies to improve medication use and meet rural adults’ health and social needs after care transitions are warranted.

Telehealth medication management and health care spending in a Medicare Accountable Care Organization.

BACKGROUND: Value-based care is an opportunity for medication optimization services to improve medication management and reduce health care spending. The reach of these services may be extended through telehealth. However, as health care systems and payers grapple with the long-term financing of telehealth, real-world assessments are needed to evaluate the potential economic impact of pharmacy-driven telehealth services. OBJECTIVE: To evaluate the impact of a scalable pharmacist-driven telehealth intervention to improve medication management on health care spending for clinically complex patients who were enrolled in a Medicare Next Generation Accountable Care Organization. METHODS: Data for this pretest-posttest nonequivalent group design study came from Medicare claims from 2015 to 2020 and linked pharmacist care activity data derived from the electronic medical record. Patients in the intervention group were identified as those who received the telehealth medication management service. Patients in the control group were offered the service and refused or could not be contacted. The primary outcome was total medical spending over a 6-month period, and impact was assessed using a covariate-adjusted difference-in-difference model. RESULTS: There were 581 patients who received the intervention and 1,765 who served as controls. The telehealth intervention reduced total medical spending by $2,331.85 per patient over the first 6 months of the service ($388.50 per month; P = 0.0261). Across a range of estimates for the cost of service delivery, we find a return on investment of 3.6:1 to 5.2:1. CONCLUSIONS: The $388.50 monthly savings found in this study represent a substantial reduction in health care spending and emphasize the opportunity for telehealth delivery of medication management services to improve value as a part of alternative payment models. DISCLOSURES: This study was funded by the UNC Health Care Department of Pharmacy. Dr Urick has received personal fees from Pharmacy Quality Solutions and Cardinal Health. Drs Peters, Vest, Colmenares, Foushee, and DeFalco are employees of UNC Health Care Department of Pharmacy. Mr Easter received a Co-PI grant from NACDS Foundation to implement Community-based Value Care Initiative (CVCI) in a community pharmacy setting. He also received a grant to Eshelman School of Pharmacy. He has an individual consulting agreement with digital health company Truentity Health to provide go to market strategy for medication management services. He also has stock options from Truentity Health as a component of the consulting agreement. Dr Foushee has a leadership or fiduciary role at Member-At-Large and the Ambulatory Care Academy of the North Carolina Association of Pharmacists. At the time this work was conducted, Dr Urick, Dr Pathak, and Dr Blanchard were all employees of the UNC Eshelman School of Pharmacy.

Application of ISO 17025 Standards in the Validation of a Spectrophotometric Method for Quality Assessment of Generic Brands of Cetirizine Tablets marketed in Nigeria.

Background: The concern for the quality of medicines is to ensure effiffifficacious clinical outcomes and quality health care. The World Health Organization (WHO) estimates that 10–20 % of medicines in&nbsp;developing country markets are sub-standard. Continuous&nbsp; monitoring of the quality of medicines&nbsp;requires both competent analysts and well-equipped drug quality control laboratories with&nbsp;&nbsp;international accreditation. The objective of the study was to evaluate the quality control parameters of&nbsp;the generic cetirizine&nbsp; dihydrochloride 10 mg tablets marketed in Abuja metropolis of Nigeria and to&nbsp;validate and apply a UV spectrophotometric method to&nbsp; the assay of the commercial tablet&nbsp;formulations.&nbsp; Method: Nine brands of cetirizine dihydrochloride tablets were randomly selected from retail&nbsp;pharmacy stores and quality control&nbsp; tests of weight variation, friability, hardness, disintegration, and&nbsp;dissolution parameters were conducted per United States&nbsp; Pharmacopoeia (USP) standards. Thickness&nbsp;and diameter were also evaluated by standard methods. AUVspectrophotometric method&nbsp; was adopted&nbsp;and validated according to ICH guidelines and applied for the drug assay of the tablet dosage units.&nbsp; Results: The&nbsp; thickness, diameter, hardness and disintegration tests for the drug samples ranged from&nbsp;2.81–3.76 mm, 3.88–8.11 mm&nbsp; 1.65–7.50 KgF and 0.44–4.90 min, respectively. All the samples met the&nbsp;compendial specififications for the weight variation test and also&nbsp; for the friability and dissolution tests&nbsp;which ranged 0.18–0.56 % and 90.15–109.18 % at 30 min, respectively. The studies for&nbsp; validation of&nbsp;the UV method demonstrated good linearity with a correlation coeffiffifficient of r2 = 0.9989 in the&nbsp;concentration range of&nbsp; 2.5–25 µg/mL of cetirizine dihydrochloride (CTZ) reference standard and the&nbsp;limit of detection (LOD) and limit of quantitation (LOQ)&nbsp; were 0.42 µg/mL and 1.29 µg/mL,&nbsp;respectively. The % RSD of the precision studies was less than the 2 % standard limit and the&nbsp; accuracy&nbsp;(recovery) ranged from 100.9‒103.4 %. The percentage contents of the generic brands were&nbsp;determined and ranged from&nbsp; 99.12–103.21 % and were within the offiffifficial specififications.&nbsp; Conclusion: The UV method was simple, sensitive and rapid and&nbsp; successfully applied to the assay of&nbsp;nine commercial brands of CTZ&nbsp; tablets. All the drugs met the compendial specififications on the quality&nbsp;parameters.&nbsp;&nbsp

Assessment of employee engagement in pharmaceutical care service at King Abdulaziz Medical City – Central region (KAMC): A cross-sectional study

BackgroundJob engagement and satisfaction are crucial for any successful institution, in recent years, organizations around the globe have begun measuring the engagement level of employees in order to improve productivity and profitability. Employee engagement has the potential to significantly affect employee retention and loyalty. This study was conducted by the pharmacy-Quality Improvement Section to assess pharmacy staff engagement in KAMC-CR in 2019 and to develop a tool to be used as employee engagement key performance indicator (KPI). Aim(1) Assessing employee engagement and satisfaction in the pharmacy Care services- central region. And (2) to develop a tool to be used as employee engagement Key Performance Indicator (KPI). MethodsThis study was conducted at the Pharmaceutical Care Service at King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children Hospital (KASCH) in Riyadh, Saudi Arabia. A validated survey was selected for the study and was then distributed via e-mail to the pharmacy staff by the quality pharmacy section in October-November 2019. The included participants were comprised of administrators, administrative assistants, clinical pharmacists, pharmacists, technicians, pharmacy aides, and pharmacy residents. There are 20 questions in the survey, and the answers were reported using a five-point Likert scale (1 = strongly disagree; 5 = strongly agree). The survey was composed of sections including demographic data, and section for staff engagement and rating of facility. ResultsParticipants in this study included 228 (54 %) employees out of a total of 420 employees. The mean health facility rating was 6.51 + 1.94 out of 10. As for the employee engagement, the mean score was 65.53 ± 13.84, and the engagement level was 24 (10.5%) had low level of engagement, 122 (53.5%) had moderate level of engagement, and 82 (36%) had high level of engagement. High level of engagement was reported among the studied sample. Employee engagement was significantly associated with occupation, work experience (p = 0.001), as well as rating of the facility (satisfaction) (p < 0.05). ConclusionPharmaceutical care services participants overall average rate of the facility by pharmaceutical care services staff as a workplace is 6.5 out of 10. The Employees engagement improves employee performance and efficiency, which contribute to an organization’s overall success.

The Use of the TARGET Antibiotic Checklist to Support Antimicrobial Stewardship in England's Community Pharmacies.

Antimicrobial Stewardship (AMS) requires effective teamwork between healthcare professionals, with patients receiving consistent messages from all healthcare professionals on the appropriate antimicrobial use. Patient education may reduce patients' expectations to receive antibiotics for self-limiting conditions and reduce the pressure on primary care clinicians to prescribe antibiotics. The TARGET Antibiotic Checklist is part of the national AMS resources for primary care and aims to support interaction between community pharmacy teams and patients prescribed antibiotics. The Checklist, completed by the pharmacy staff with patients, invites patients to report on their infection, risk factors, allergies, and knowledge of antibiotics. The TARGET antibiotic checklist was part of the AMS criteria of England's Pharmacy Quality Scheme for patients presenting with an antibiotic prescription from September 2021 to May 2022. A total of 9950 community pharmacies claimed for the AMS criteria and 8374 of these collectively submitted data from 213,105 TARGET Antibiotic Checklists. In total, 69,861 patient information leaflets were provided to patients to aid in the knowledge about their condition and treatment. 62,544 (30%) checklists were completed for patients with an RTI; 43,093 (21%) for UTI; and 30,764 (15%) for tooth/dental infections. An additional 16,625 (8%) influenza vaccinations were delivered by community pharmacies prompted by discussions whilst using the antibiotic checklist. Community pharmacy teams promoted AMS using the TARGET Antibiotic Checklist, providing indication-specific education and positively impacting the uptake of influenza vaccinations.