American Journal of Health-System Pharmacy最新文献

{"title":"Implementation of a pharmacy technician-driven, technology-assisted final product verification program at a community teaching hospital.","authors":"Bryanna M Dunston, Steven A Sohasky, Lindy M Farwig, Benjamin D Kulwicki","doi":"10.1093/ajhp/zxaf013","DOIUrl":"10.1093/ajhp/zxaf013","url":null,"abstract":"<p><strong>Purpose: </strong>Technology-assisted final product verification (TAFPV) is a process whereby a licensed pharmacy technician validates the work of another using a technology such as barcode scanning. While similar to tech-check-tech (TCT), TAFPV requires that technology is utilized in the final verification process. As of 2024, 28 states allowed this practice. In October 2021, the Michigan Board of Pharmacy passed allowances for TAFPV to be conducted in the state. This report describes the implementation of a TAFPV program and its impact on pharmacy operations.</p><p><strong>Summary: </strong>Following technology and site readiness assessments, a TAFPV program was implemented at a community teaching hospital. Three months post implementation, 4,193 filled medication orders were verified by validated pharmacy technicians (VPTs) with 100% accuracy. Fifty-seven dispensing errors were identified by VPTs upon verification. The median time from medication procurement to final verification for VPTs was 138 seconds (interquartile range [IQR], 53-465) compared to 218 (IQR, 39-736) for pharmacists (P = 0.01). The mean (SD) amount of time spent verifying medication orders daily was 4.57 (0.12) hours for VPTs and 4.53 (0.14) hours for pharmacists (P = 0.97).</p><p><strong>Conclusion: </strong>Implementation of a TAFPV program improved inpatient pharmacy operational efficiencies while preserving medication safety. A future area of study includes measuring the impact of clinical services provided by pharmacists utilizing the reallocated time from the TAFPV program.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e767-e771"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045561","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":"Reimbursement for services provided by clinical pharmacists in primary care: Description of changes over time in an academic primary care network in Ohio following the recognition of pharmacists as providers.","authors":"Cory P Coffey, Kelli D Barnes, Neeraj H Tayal, Daniel E Jonas, Stuart J Beatty","doi":"10.1093/ajhp/zxaf021","DOIUrl":"10.1093/ajhp/zxaf021","url":null,"abstract":"<p><strong>Purpose: </strong>In January 2021, Ohio pharmacists were recognized by Medicaid as providers, became eligible to obtain Medicaid provider identification numbers, and were able to begin billing for services using evaluation and management codes. The objectives of this study were to compare outcomes before (2020) and after (2021 and 2022) pharmacist provider status was implemented in a network of primary care clinics: (1) the percent change in pharmacist-provided services that were billed and reimbursed, 2) the percent change in pharmacist-provided services that were billed as \"incident-to\" versus with the pharmacist as provider, and (3) the percent change in reimbursement per encounter as a result of pharmacist-provided services.</p><p><strong>Methods: </strong>A retrospective review of all encounters and administrative claims (all payors) provided by pharmacists (7.9 full-time equivalents) within 7 primary care clinics affiliated with a large academic medical center was conducted. The data were compared year-to-year using descriptive statistics to determine the magnitude of change.</p><p><strong>Results: </strong>A total of 14,416 encounters were included in the study (1,863 in 2020, 4,963 in 2021, and 7,590 in 2022). In 2020, 37.8% (705/1,863) of pharmacist encounters were billed for reimbursement. In 2021, this percentage increased to 39.1% (1,939/4,963) encounters, with a further increase in 2022 to 49.1% (3,725/7,590). Differences in the percentage of pharmacist encounters billed as incident-to versus pharmacist as provider were also evident, with 37.8% (705/1,863) of pharmacist encounters billed incident-to in 2020, as compared to 36.8% (2,796/7,590) in 2022. In this same time period, mean reimbursement for pharmacist-as-provider encounters increased by 189.5% (from $10.45 to $30.25) per encounter, and the number of pharmacist-as-provider encounters increased year over year (from 0% [0/1863] in 2020 to 1.1% [54/4,963] in 2021 and 12.3% [929/7,590] in 2022; P < 0.001).</p><p><strong>Conclusion: </strong>This study found an increase in the billing and reimbursement attributable to clinical pharmacists in primary care settings in Ohio after their recognition as providers.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e760-e766"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254335","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":"From patient to practitioner: A pharmacist's perspective as a clinical trial participant.","authors":"Shay Roth","doi":"10.1093/ajhp/zxaf039","DOIUrl":"10.1093/ajhp/zxaf039","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e785-e787"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555539","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":"Antifungalgram: A unique tool to track fungal resistance.","authors":"Zoey Sjogren, Amanda Bushman, Jessi Holter, Sudhir Kumar","doi":"10.1093/ajhp/zxaf070","DOIUrl":"10.1093/ajhp/zxaf070","url":null,"abstract":"<p><strong>Purpose: </strong>The prevalence of Candida infections increases each year in the US. The most common Candida species are Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei. Because of concerns about emerging resistance and impact on clinical outcomes, selection of appropriate empiric antifungal therapy is crucial. At our institution, an antifungalgram was created to help monitor antifungal susceptibility patterns.</p><p><strong>Methods: </strong>A retrospective chart review was conducted at UnityPoint Health-Des Moines for the time period from January 2013 to July 2023. Patients were included if they had a sterile site culture positive for C. albicans, C. glabrata, C. parapsilosis, C. krusei, or C. tropicalis. Species were excluded if the sample size was fewer than 10 isolates or if susceptibility data were not available. The objective of this study was to evaluate the quantity and type of sterile site Candida species isolates and antifungal susceptibility to create an antifungalgram.</p><p><strong>Results: </strong>This study reviewed 251 sterile site Candida isolates, of which 242 were included. Of the 242 sterile site isolates, 218 (90.1%) were from adult patients and 24 (9.9%) were from neonatal/pediatric patients. C. albicans was the most common organism with 132 (54.5%) isolates, followed by C. glabrata (74 isolates, 30.6%), C. parapsilosis (25 isolates, 10.3%), and C. tropicalis (11 isolates, 4.5%). The susceptibility rates for each Candida species were summarized.</p><p><strong>Conclusion: </strong>The creation of a local antifungalgram helps to detect resistance patterns within healthcare systems and may guide empiric antifungal therapy selection.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"S2951-S2954"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676811","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":"The impact of a customized electronic health record clinical decision support tool on pharmacist renal dosing interventions.","authors":"Brandyn Wilcox, James Sanders, Candace Sutton, Meagan Johns","doi":"10.1093/ajhp/zxaf071","DOIUrl":"10.1093/ajhp/zxaf071","url":null,"abstract":"<p><strong>Purpose: </strong>A customized Epic scoring tool for monitoring medications requiring renal dose adjustment utilizing Epic Bugsy and a custom renal function trend scoring column was developed and implemented in June 2023 at UT Southwestern Medical Center (UTSW) to replace the manual review and intervention (i-Vent) documentation process.</p><p><strong>Methods: </strong>This retrospective, observational cohort study evaluated pharmacist interventions and antimicrobial dosing before and after implementation of the UTSW renal clinical pharmacist responsibility (CPR) dose adjustment tool. Adult patients (aged 18 years or older) requiring renal dose adjustment were included. The preintervention group included patients admitted between July 1 and August 31, 2022, whereas the postintervention group included patients admitted from July 1 through August 31, 2023. Patients exempt from the institutional automatic adult renal dosing guideline (ie, those with cystic fibrosis, solid organ transplantation, or bone marrow transplantation) or actively receiving renal replacement therapy during the index encounter were excluded.</p><p><strong>Results: </strong>In a comparable 2-month timespan, implementation of the renal CPR dose adjustment tool resulted in a 68.2% increase in the number of renal dosing interventions completed (P < 0.0001), a 47.2% reduction in the number of unique alerts requiring pharmacist review (P < 0.0001), and an increase in the proportion of actionable interventions per alert requiring review from 11.1% before implementation to 39.4% after implementation (P < 0.0001). Pharmacist satisfaction with the renal monitoring workflow also improved with implementation.</p><p><strong>Conclusion: </strong>In a comparable 2-month timespan, implementation of the renal CPR dose adjustment tool at UTSW resulted iin improvements in interventions completed, a reduction in alerts requiring review, an increased total duration that selected antimicrobials were dosed appropriately, and improved pharmacist satisfaction.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"S2963-S2973"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762512","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":"Comment on \"Getting back on the curve: Reimagining individualized, sustainable residency training for the critical care pharmacist\".","authors":"Darrick Emery, Scott Nei","doi":"10.1093/ajhp/zxaf065","DOIUrl":"10.1093/ajhp/zxaf065","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"864-865"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584138","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":"Therapeutic advances in chronic lymphocytic leukemia: A focus on molecular pathogenesis, targeted therapies, and supportive care.","authors":"Clement Chung","doi":"10.1093/ajhp/zxaf058","DOIUrl":"10.1093/ajhp/zxaf058","url":null,"abstract":"<p><strong>Purpose: </strong>This article concisely evaluates current targeted therapies that have received regulatory approval for chronic lymphocytic leukemia (CLL). Mechanisms of molecular pathogenesis and their therapeutic implications, current and novel targeted therapies, and supportive care are discussed.</p><p><strong>Summary: </strong>CLL is a common lymphoproliferative neoplasm of mature but immunologically incompetent B cells in older adults. Over the past 2 decades, robust research has shown that CLL pathogenesis is a multistep process that includes, but is not limited to, (1) clonal selection, expansion, and transformation; (2) aberrant B cell signaling pathways; (3) sequence heterogeneity in the gene encoding the immunoglobulin heavy chain variable region (IGHV); (4) impaired apoptosis; and (5) interactions between CLL cells and their microenvironment. The development of oral targeted therapies against some of these molecular abnormalities has led to improved survival outcomes over traditional chemoimmunotherapy. Current oral targeted therapies that have received regulatory approval include continuous therapy with Bruton's tyrosine kinase inhibitors (BTKis) and fixed-duration therapy with the B cell leukemia/lymphoma-2 inhibitor (BCL-2i) venetoclax. These agents may be used either alone or in combination in the treatment-naive setting, as well as in relapsed or refractory disease. This review contributes to understanding of the molecular pathogenesis of CLL with therapeutic implications. It summarizes key advances in oral targeted therapies and emerging innovative targeted therapies (eg, novel BTKis, BTK degraders, and novel BCL-2is) and highlights supportive care in optimizing treatment-related adverse effects.</p><p><strong>Conclusion: </strong>Treatment options for CLL continue to evolve. Current treatment selection is based on clinical and patient-specific considerations. Emerging novel therapies to overcome treatment resistance and strategies to optimize supportive care generate opportunities for pharmacists to advance practice and improve patient safety.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"868-885"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603313","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":"Response to Emery and Nei.","authors":"Brian Murray","doi":"10.1093/ajhp/zxaf066","DOIUrl":"10.1093/ajhp/zxaf066","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"866-867"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584164","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":"Nonopioid medications for managing opioid withdrawal in acute care settings: A scoping review.","authors":"Brian L Erstad, Aurora N Quaye, Megan E Hellwege, David Do, Brian J Kopp","doi":"10.1093/ajhp/zxae371","DOIUrl":"10.1093/ajhp/zxae371","url":null,"abstract":"<p><strong>Purpose: </strong>There are hospitalized patients with chronic opioid use who will experience signs and symptoms of opioid withdrawal who were not on medications for opioid use disorder (OUD) prior to admission, do not want to start or are unable to start medications for OUD during admission, and want to limit or avoid the use of opioids. The purpose of this scoping review was to assess the potential effectiveness and safety of using non-opioid agents for managing acute opioid withdrawal in acute care settings.</p><p><strong>Methods: </strong>PubMed (inception to 2024), Embase (inception to 2024), and Cochrane Library (inception to 2024) were the databases evaluated for the literature search. Bibliographies of full-text articles were reviewed for additional relevant papers.</p><p><strong>Results: </strong>Twenty-eight studies evaluating nonopioid agents for managing acute opioid withdrawal were identified in the literature search. The agents could be divided into 4 broad mechanistic categories: α-adrenergic receptor agonists, N-methyl-d-aspartate (NMDA) antagonists, gamma-aminobutyric acid (GABA) modulators, and serotonergic agents. Of these drug classes, the available literature suggests the α-adrenergic receptor agonists clonidine and lofexidine have the best evidence of efficacy as alternative agents for acute opioid withdrawal, although the majority of studies comparing such agents to opioids for opioid withdrawal were conducted well before the rise in synthetic opioid overdose deaths and have other methodologic issues that limit firm conclusions concerning efficacy and, particularly, safety.</p><p><strong>Conclusion: </strong>For the nonopioid alternative agents that have been studied for acute opioid withdrawal, there is more evidence supporting the efficacy of α-adrenergic receptor agonists as opposed to NMDA antagonists, GABA modulators, or sertonergic agents; however, more research is needed regarding the efficacy and safety of nonopioid alternatives for acute opioid withdrawal in order to better guide clinical decision-making.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"898-905"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806042","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":"Pharmacy technician education and training: Highlighting the partnership among a state pharmacy association, local community college, and healthcare system.","authors":"Richard Yik, Marissa C Salvo","doi":"10.1093/ajhp/zxae410","DOIUrl":"10.1093/ajhp/zxae410","url":null,"abstract":"<p><strong>Purpose: </strong>Well-educated and well-trained pharmacy technicians play an integral part in the operation of pharmacies. However, recently, the pharmacy technician workforce has been declining due to many factors, including low salary, limited career advancement, and increasing responsibilities. Here a pharmacy technician student education and training partnership among a state pharmacy association, a community college, and a healthcare system is described.</p><p><strong>Summary: </strong>Through this novel partnership, the state association provides the curriculum and instructors for the community college to offer the course and the health system provides real-world experiences. The dedicated course with didactic and simulation opportunities, coupled with the experiential learning opportunity, following successful course completion, can prepare pharmacy technician students to enter the workforce and potentially address recent workforce shortages.</p><p><strong>Conclusion: </strong>Collaboration among a state pharmacy association, a community college, and a healthcare system or pharmacy may be a viable model in providing pharmacy technician education and training programs. Partnered health systems or pharmacies may benefit from having a consistent pool of well-trained, diverse, and dedicated pharmacy technicians to add to the workforce.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"915-920"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920393","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}