Journal of the American Pharmacists Association最新文献

{"title":"TikTok's Take on Side Effects for Glucagon-Like Peptide-1 and Gastric Inhibitory Polypeptide Receptor Agonists.","authors":"Gwendolyn A Wantuch, Jerica Singleton","doi":"10.1016/j.japh.2025.102384","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102384","url":null,"abstract":"<p><strong>Background: </strong>TikTok's MedTok is an interconnected network of patients, providers, and producers sharing knowledge and experiences of health-related topics. Awareness of popular content on weight loss medications can benefit healthcare professionals, especially regarding side effects and management.</p><p><strong>Objectives: </strong>Describe content in popular TikTok videos using side effect hashtags for gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists. Compare content between healthcare and non-healthcare creators and reported side effects versus medication package inserts.</p><p><strong>Methods: </strong>This observational study evaluated videos for popular GLP-1 and GIP receptor agonist side-effect hashtags on TikTok, in June 2023. Video metadata collected included content creator demographics, and content of video including side effects discussed and recommendations to address these. Side effects were compared to package insert data. Qualitative data was evaluated through descriptive coding, quantitative data through descriptive statistics and Pearson chi-square for comparisons.</p><p><strong>Results: </strong>A total of 165 videos were analyzed. Content creators were mostly medication users (89%) and non-healthcare professionals (90%). Medication indications included weight loss (82%), PCOS (20%), and diabetes (6%). Diet, exercise, or weight loss were discussed in 34%, 16%, and 38% of videos, respectively. Non-healthcare professionals mentioned specific products to address side effects more frequently than healthcare professionals, 24% versus 13% (p = 0.292). All side effects mentioned in at least five videos aligned with medication package inserts, most commonly gastrointestinal disturbances, except for insomnia.</p><p><strong>Conclusion: </strong>Most content creators were non-healthcare professionals and medication users. Despite Ozempic and Mounjaro lacking FDA approval for weight loss at the time, it was the most identified indication. The alignment of most reported side effects with medication package inserts underscores the reliability of user-shared experiences, though discrepancies like insomnia were noted. Given TikTok's significant reach and influence, awareness of patient-reported experiences and recommendations is essential for healthcare providers to enhance care and dispel misconceptions.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102384"},"PeriodicalIF":2.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel programs to improve patient access and understanding of Medications: Nashville General Hospital Pharmacy Services.","authors":"J Jacob Wetsell, Jeff Hardwick, Evelyn Henson, Alecia Fair, Debra Wujcik, Joseph Webb","doi":"10.1016/j.japh.2025.102383","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102383","url":null,"abstract":"<p><strong>Background: </strong>Nashville General Hospital (NGH) is a public safety-net hospital serving Nashville, Tennessee and surrounding areas. Surveys sent after hospital discharge showed patients were dissatisfied with their understanding of their medications. Patients also often had difficulty obtaining and paying for medications post discharge.</p><p><strong>Objectives: </strong>The primary objective was to address the patient's dissatisfaction with their understanding of the purpose of their medications. The second objective was to remove the financial barrier of obtaining medications for those patients who were under or uninsured. To address these needs NGH uses a three-pronged approach: the Meds2Beds (M2B), Hope Meds (HM) programs, and the NGH Foundation (NGHF).</p><p><strong>Methods: </strong>The M2B and HM programs were implemented in March 2023, whereas NGHF was pre-existing. Medications are filled at NGH Community Pharmacy, a retail pharmacy on the NGH campus, and delivered prior to discharge. Pharmacists teach patients about the purpose of their medications, how to take them, and what to expect in terms of both side effects and outcomes. Patients who meet eligibility criteria receive prescriptions free of charge via HM and NGHF.</p><p><strong>Results: </strong>In one year the M2B program has provided counseling to 993 unique patients. The HM Program has served 4,673 unique patients, filled 4,744 prescriptions and provided 7,976 months of free medications, saving NGH patients $598,054. In addition, the NGHF provided medications to 1,335 patients for this period, providing savings of $35,215. The average time spent with patients is 15 minutes.</p><p><strong>Conclusion: </strong>The unique blend of programs at NGH serves to address barriers to medication access and understanding. These programs are feasible, and with minimal pharmacist burden leading to improved patient satisfaction and adherence.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102383"},"PeriodicalIF":2.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Evaluation of a Pharmacist-led Glucagon-like Peptide-1 Receptor Agonist Titration Service in Two Primary Care Clinics.","authors":"Kristel Miller, Erin Carson, Kimber Boothe, Bethanne Brown","doi":"10.1016/j.japh.2025.102385","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102385","url":null,"abstract":"<p><strong>Background: </strong>People with type 2 diabetes are increasingly prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs) which require frequent follow-up for tolerability and dose optimization. To prevent clinical inertia, ambulatory care pharmacists are well-positioned to provide titration services to reduce prescriber burden.</p><p><strong>Objectives: </strong>The objective of this study was to describe the implementation and evaluation of a pharmacist-led GLP-1 RA titration service.</p><p><strong>Practice description: </strong>The two clinics included in this study are part of a community-based health system serving northern Illinois.</p><p><strong>Practice innovation: </strong>Included clinics are staffed by an ambulatory care pharmacist working under a delegation protocol. Initial encounters address medication accessibility and education. Follow-up visits evaluate tolerability, blood glucose control, and dose optimization.</p><p><strong>Evaluation methods: </strong>The primary endpoint was the absolute change in hemoglobin A1c (A1c) from baseline to 3-6 months post-titration. Paired t-tests were used for statistical comparisons.</p><p><strong>Results: </strong>From September 2022 to May 2023, 120 patients met inclusion criteria; 8 patients stopped therapy. Mean baseline A1c was reduced by -1.8% (P<0.001) at 3-6 months post-titration. Average change in weight was -8.1 kg (N=107) (P<0.001). The number of diabetic medications decreased from an average of 2.5 to 2.1 medications. The percentage of patients meeting Healthcare Effectiveness Data and Information Set (HEDIS) measures for diabetes after pharmacist intervention were 97.3% for blood pressure under 140/90 mm Hg, 95.5% for A1c under 8%, 100% for serum creatinine tested in last 12 months, and 90.2% for urine microalbumin/ creatine ratio (UACR) tested in last 12 months. The average patient required 6.5 encounters and 91 total pharmacist minutes to achieve GLP-1 RA optimization. Approximately 0.1 full-time equivalents of pharmacist coverage were required over 13 months to manage 120 patients.</p><p><strong>Conclusions: </strong>Ambulatory care pharmacists can effectively optimize GLP-1 RAs to improve clinical outcomes, meet quality-based metrics, and reduce prescriber burden.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102385"},"PeriodicalIF":2.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Australian community pharmacists’ experiences of prescription drug monitoring programs: Comparisons between mandated and nonmandated states","authors":"Rose Laing ,&nbsp;Pei Ying ,&nbsp;Ting Xia,&nbsp;Suzanne Nielsen,&nbsp;Louisa Picco","doi":"10.1016/j.japh.2024.102313","DOIUrl":"10.1016/j.japh.2024.102313","url":null,"abstract":"<div><h3>Background</h3><div>Prescription drug monitoring programs (PDMPs) track patients’ prescription records for high-risk medications and prompt real-time alerts to pharmacists when specific criteria are met. PDMPs are increasingly implemented by health care systems to attempt to mitigate harms associated with prescription opioids.</div></div><div><h3>Objective</h3><div>This study aims to explore and compare PDMP experiences among Australian community pharmacists from states where PDMP use is mandated and nonmandated.</div></div><div><h3>Methods</h3><div>A representative sample of community pharmacists from New South Wales, Queensland, Victoria, and Western Australia were invited to complete an anonymous online survey. The survey collected pharmacy and pharmacist-related information and asked pharmacists to rank PDMP’s usefulness and barriers on a 5-point scale. Mann-Whitney <em>U</em> tests were conducted to determine if there were statistically significant differences in scores between mandated and nonmandated states.</div></div><div><h3>Results</h3><div>In total, 690 pharmacists were included. Pharmacists in mandated states had statistically higher mean ‘usefulness’ scores for 5 out of 17 items, such as informing clinical decision-making (<em>P</em> &lt; 0.001) and increasing confidence to refuse medication supply (<em>P</em> = 0.002). PDMP-related barriers were rarely reported by pharmacists, although there were statistically significant differences for specific barriers between mandated and nonmandated states. Nonmandated states had significantly higher mean scores for 5 barriers, including ‘unsure what to do with the PDMP information’ (<em>P</em> &lt; 0.001) and ‘PDMP is not integrated into dispensing software’ (<em>P</em> = 0.005). Mandated states had statistically higher mean scores for 9 barriers, including ‘not all scripts appear in PDMP’ (<em>P</em> &lt; 0.001) and ‘inaccurate information in the PDMP’ (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>There were significant differences in pharmacists’ PDMP experiences between mandated and nonmandated states, which may have policy implications given Australia’s recent investment into national prescription monitoring.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102313"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing SGLT-2 inhibitor prescribing through an integrated case-finding algorithm-guided interdisciplinary intervention","authors":"Cindy Leslie A. Roberson,&nbsp;Abby F. Hoffman,&nbsp;Pamela Cohen,&nbsp;Victoria Lee Jackson,&nbsp;Susan E. Spratt","doi":"10.1016/j.japh.2024.102320","DOIUrl":"10.1016/j.japh.2024.102320","url":null,"abstract":"<div><h3>Background</h3><div>Use of sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors) falls short of their cardiorenal protective benefits. Patient and provider-level barriers hinder the adoption of these life-saving medications. Innovative practices to provide primary care providers (PCPs) with added clinical-decision support via a dedicated remote interdisciplinary diabetes rounds (IDRs) team could promote SGLT-2 inhibitor selection.</div></div><div><h3>Objective</h3><div>To evaluate the impact of the IDR's proactive provider outreach on the prescribing rate of SGLT-2 inhibitors and assess the application of an SGLT-2 inhibitor case-finding algorithm to allow targeted intervention in a population-health-based setting.</div></div><div><h3>Methods</h3><div>This is a quality improvement prospective cohort observational study from October 2021 to May 2022. Patients who met the prespecified criteria for SGLT-2 eligibility were reviewed via IDR with recommendations sent to the PCP via the electronic health record. The primary analysis employed a multivariate logistic regression to assess the difference in SGLT-2 inhibitor prescription rates between reviewed and not reviewed patients, adjusting for variables affecting SGLT-2 inhibitor prescribing. The secondary analysis measured the algorithm's accuracy in identifying patients with compelling indications.</div></div><div><h3>Results</h3><div>The IDR team reviewed a total of 206 patients (mean age, 63 years; 53.9% women; 42.7% Black; mean A1c 8.3%) with a successful PCP appointment. Patients reviewed by the IDR team had an increased prescribing rate within 90 days of the visit (adjusted odds ratio 5.1, 95% CI 3.06–8.47). The algorithm identified 1084 SGLT-2 inhibitor-eligible patients with a sensitivity of 90.4% (95% CI, 86.4%, 94.4%) and specificity of 85.1% (95% CI, 79.9%, 90.4%).</div></div><div><h3>Conclusion</h3><div>IDR team's review of eligible patients with recommendations to PCPs was associated with significantly increased SGLT-2 inhibitor prescription rates. Development of an algorithm with high sensitivity and specificity for targeted intervention may provide a pathway for channeling therapy and decreasing clinical inertia in population health management efforts.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102320"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist perceptions of motivation and well-being using self-determination theory: A qualitative study","authors":"Kayla Walker,&nbsp;Alexcia S. Carr,&nbsp;Andrew Wash,&nbsp;Leticia R. Moczygemba","doi":"10.1016/j.japh.2024.102321","DOIUrl":"10.1016/j.japh.2024.102321","url":null,"abstract":"<div><h3>Background</h3><div>Many US hospitals and health systems have implemented well-being programs to address the clinician well-being and burnout crisis. Most community pharmacists experience at least one symptom of burnout, yet they have been overlooked for inclusion in well-being initiatives.</div></div><div><h3>Objective</h3><div>To explore community pharmacists' perceptions of how motivation and burnout impact patient care and how fulfillment of basic psychological needs (autonomy, competence, and relatedness) impacts motivation and well-being.</div></div><div><h3>Methods</h3><div>Focus groups were conducted with 20 community pharmacists. A semistructured focus group guide was developed using Self-Determination Theory (SDT). Transcriptions from the focus groups were analyzed using deductive qualitative analysis with SDT as a framework and inductive analysis to code subthemes.</div></div><div><h3>Results</h3><div>Our findings revealed that pharmacists who feel burnout experience depersonalization toward patients which lowers the quality of patient-pharmacist interactions. Pharmacists who did not feel burnout expressed a sense of professional fulfillment, which motivated them to provide patient-centered care. Pharmacists indicated that unrealistic expectations from patients and corporate management, such as pressure from patients to fill prescriptions quickly and management expectations to meet prescription fill quotas, negatively impacted autonomy. Conversely, having access to clinical information, workflow optimization, and realistic job expectations supported autonomy. Poor relationships with patients and coworkers negatively impacted relatedness and contributed to communication barriers, workplace negativity, and emotional detachment from work. Relatedness was facilitated by building relationships and mutual respect with patients and coworkers and cultivating a positive work culture. Expectations for perfection and the need for multitasking when understaffed diminished competency. Adequate staffing and allocation of time to complete job duties served to support competency.</div></div><div><h3>Conclusion</h3><div>Community pharmacists are faced with situations that undermine autonomy, relatedness, and competency, which according to SDT need to be fulfilled to facilitate well-being.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102321"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing pharmacy deserts and designing a model to minimize inequities in pharmacy distribution in Virginia","authors":"Joseph Boyle,&nbsp;Rachel Wittenauer,&nbsp;Shreya Ramella,&nbsp;Caroline Juran,&nbsp;John D. Bucheit,&nbsp;Evan M. Sisson,&nbsp;Jean-Venable (Kelly) Goode,&nbsp;Sharon S. Gatewood,&nbsp;Teresa M. Salgado","doi":"10.1016/j.japh.2025.102334","DOIUrl":"10.1016/j.japh.2025.102334","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacy closures have become increasingly prevalent in the United States in recent years. Previous literature highlights socioeconomic and racial disparities in the distribution of pharmacy deserts.</div></div><div><h3>Objectives</h3><div>To identify and characterize pharmacy deserts in Virginia and to simulate potential locations to minimize inequities in pharmacy distribution.</div></div><div><h3>Methods</h3><div>This cross-sectional study used active pharmacy permits data from the Virginia Board of Pharmacy to identify census tracts considered pharmacy deserts by simultaneously satisfying 2 criteria: 1) low-income status (&gt;20% residents living below the federal poverty line, or median household income &lt;80% of a local comparator); and 2) low-access to pharmacies (distance &gt;1, 5, or 10 miles for urban, suburban, and rural census tracts, respectively). Demographic and socioeconomic characteristics of desert vs. nondesert tracts were compared using Wilcoxon rank-sum tests. Locations within identified pharmacy deserts were randomly generated in 10,000 independent iterations.</div></div><div><h3>Results</h3><div>Of 2198 census tracts, 51 were considered pharmacy deserts, and 69 met the low-access criterion only. Pharmacy deserts were significantly more common in urban census tracts (5.5%), followed by rural (2.9%), and suburban (0.1%). Compared to nondesert, pharmacy desert tracts had significantly lower percentage of residents under 18 year-old, greater percentage of Black residents, uninsured, with Medicare or Medicaid coverage only, lower median household income, and greater percentage of residents living in poverty. Through geospatial simulation, 44 locations were identified where adding pharmacy services could significantly improve access, each potentially benefiting over 10,000 individuals.</div></div><div><h3>Conclusion</h3><div>Fifty-one tracts in Virginia, primarily in urban areas, were considered pharmacy deserts. Compared to nondeserts, pharmacy desert status was associated with a lower proportion of residents under 18 year-old, greater proportion of Black and uninsured/publicly insured residents, and high poverty level, highlighting disparities in pharmacy access. Geospatial simulation identified several locations where placement of pharmacy services could benefit the largest number of residents living in desert tracts.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102334"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Availability of and attitudes toward harm reduction services: A rural pharmacy perspective","authors":"Grace Marley,&nbsp;Erin Blythe,&nbsp;Salisa Westrick,&nbsp;Delesha M. Carpenter","doi":"10.1016/j.japh.2024.102291","DOIUrl":"10.1016/j.japh.2024.102291","url":null,"abstract":"<div><h3>Background</h3><div>There's limited information available about the range of harm reduction (HR) services provided by rural pharmacies.</div></div><div><h3>Objective</h3><div>This study’s objectives are to describe the types of HR services offered by rural pharmacies and examine pharmacists’ attitudes and willingness to offer those services.</div></div><div><h3>Methods</h3><div>A cross-sectional online survey was sent to pharmacists who are members of a practice-based research network for rural community pharmacies. Pharmacists reported the frequency to which their pharmacy engage in as well as their willingness to offer the following HR services: naloxone dispensing; buprenorphine dispensing; point of care testing for human immunodeficiency virus (HIV) and Hepatitis C (HCV); and nonprescription syringe (NPS) sales. Also, pharmacists' knowledge and willingness to sell drug test strips and attitudes toward people who inject drugs (PWIDs) were assessed. Descriptive statistics were calculated.</div></div><div><h3>Results</h3><div>A total of 61 pharmacists completed the survey (completion rate = 45.2%). Most reported dispensing naloxone 2-3 times per month (90.2%), and a third dispensed buprenorphine daily (32.8%). Only one pharmacy offered HIV testing, and none offered HCV testing. Most pharmacies (65.6%) had a policy regarding the sale of NPS, with 21.3% reporting they never dispense nonprescription syringes. Many pharmacists were willing to sell fentanyl test strips (67.2%) and xylazine test strips (50.8%). Pharmacists’ most negative attitudes related to believing PWID customers make other customers feel uncomfortable and that providers keep patients on buprenorphine for too long.</div></div><div><h3>Conclusion</h3><div>Many rural community pharmacists engage in HR services and are willing to offer more. However, stigmatizing attitudes highlight the need for pharmacy-focused HR training to reduce stigma and increase knowledge.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102291"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a productivity model at a pharmacy consolidated service center","authors":"Amelia Hornaday,&nbsp;Philipp Monterroyo,&nbsp;Lindsay Reulbach,&nbsp;Catherine Bishop,&nbsp;Harrison Jozefczyk","doi":"10.1016/j.japh.2024.102298","DOIUrl":"10.1016/j.japh.2024.102298","url":null,"abstract":"<div><h3>Background</h3><div>Health systems have implemented pharmacy consolidated service centers (PCSCs) to address increased patient volume, elevated drug costs, and decreased reimbursements. Assessing pharmacy productivity remains a challenge given that metrics have historically been determined by calculations of variables that do not capture the actual work. Several investigators have demonstrated improved labor outcomes in health-system pharmacy with the use of novel productivity models. However, the utility of a novel productivity model at a PCSC has not been assessed.</div></div><div><h3>Objective</h3><div>This study aimed to develop a productivity model with validation by comparison to past time periods to represent work at a PCSC.</div></div><div><h3>Methods</h3><div>The amount of time needed to complete work was determined by performing time studies. A modified Delphi process was used to ensure an appropriate perception of workload. Time standards for each category were averaged to determine the specific relative value units, which were then multiplied by total biweekly orders and combined with fixed activities to determine the unit of service. Actual hours worked were obtained for 6 prior pay periods to compare tool productivity with actual productivity.</div></div><div><h3>Results</h3><div>Time studies were performed over a 3-month period. The total average hours per pay period calculated by the tool for repackaging was 167.4 or 2.1 full-time equivalents (FTEs) and for warehousing was 176.8 or 2.2 FTEs. Although tool productivity followed the same trends as historical calendar day productivity, it was consistently higher per pay period over the 12-week comparison.</div></div><div><h3>Conclusion</h3><div>By performing time studies, a productivity model was developed for a PCSC that generated productivity data that correlated with 12 weeks of data using a historical model. This study provides the ability to assess trends over time with a more precise evaluation of work leading to the discussion that this tool is superior to historical productivity models.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102298"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term opioid therapy in older adults: Incidence and risk factors related to patient characteristics and initial opioid dispensed","authors":"Iftekhar Ahmed,&nbsp;Alan J. Zillich,&nbsp;Noll L. Campbell,&nbsp;Kevin M. Sowinski,&nbsp;David R. Foster","doi":"10.1016/j.japh.2024.102311","DOIUrl":"10.1016/j.japh.2024.102311","url":null,"abstract":"<div><h3>Background</h3><div>The clinical benefits of long-term opioid therapy (LTOT) are not clearly known; however, LTOT is associated with various adverse outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to estimate the incidence and risk factors associated with LTOT in adults aged ≥ 65 years.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study using Medicare claims data. Opioid-naïve older adults filling an opioid prescription between 2014 and 2016 were included. The outcome variable was LTOT, defined as an opioid use episode longer than 90 days and having &gt; 60 cumulative days of supply. Predictor variables included patient characteristics, characteristics of initial opioid dispensed, and pain conditions. Multivariable logistic regression was performed to assess the association between predictors and LTOT.</div></div><div><h3>Results</h3><div>Among 162,287 participants, 10,296 (6.3%) met the definition of LTOT. Key patient characteristics associated with LTOT were age &gt; 85 years (adjusted odds ratio 1.13 [95% confidence interval 1.05–1.21]); &gt; 5 comorbidities (1.55 [1.45–1.65]); and history of drug use disorder (1.53 [1.35–1.74]), alcohol use disorder (1.38 [1.23–1.54]), tobacco use disorder (1.31 [1.23–1.40]), and opioid use disorder (2.00 [1.69–2.37]). Characteristics of initial opioid associated with LTOT were dispensing long-acting opioids (1.72 [1.21–2.44]) and concomitant use of benzodiazepines (1.16 [1.08–1.25]), gabapentinoids (1.57 [1.47–1.67]), and prescription nonsteroidal anti-inflammatory drugs (1.24 [1.17–1.31]). Anxiety disorders were associated with 1.4-1.5 times increased odds of LTOT. Moreover, initial opioid supply of ≥ 30 days led to 11-16 times higher odds of LTOT than days’ supply of 1-3 days.</div></div><div><h3>Conclusions</h3><div>Factors related to patient characteristics (age, number of comorbidities, substance use disorders, anxiety disorders) and initial opioid dispensation (duration of action, certain concomitant medications, days’ supply) are associated with LTOT in older adults. Prescribers should consider these factors when prescribing opioids to senior patients.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102311"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}