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Vicente-Escrig E, Bonastre PT, Barrueta OI, Izquierdo MM, Fernández-Llamazares CM, Morillo-Verdugo R. [Translated article] Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by Regions in Spain. FARMACIA HOSPITALARIA 2024; 48:T64-T69. [PMID: 38151407 DOI: 10.1016/j.farma.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching, and investigation. It was carried out in 2 periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialisation of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress toward excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, Spain
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Vicente-Escrig E, Taberner Bonastre P, Ibarra Barrueta O, Murillo Izquierdo M, Fernández-Llamazares CM, Morillo-Verdugo R. Analysis 2016-2021 of the development of the MAPEX outpatient pharmaceutical care Project by regions in Spain. FARMACIA HOSPITALARIA 2024; 48:64-69. [PMID: 37749003 DOI: 10.1016/j.farma.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Analyse the evolution of the MAPEX Project (Strategic Map of Pharmaceutical Care for Outpatients) by regions in Spain, through the results of the comparative situation survey between the years 2016 and 2021. METHODS A committee of national experts belonging to the Spanish Society of Hospital Pharmacy prepared the MAPEX Survey on the situation of Outpatient Units, which consisted of 43 specific questions on aspects related to structure, context, integration, processes, results and training, teaching and investigation. It was carried out in two periods, one in 2016 and another in 2021 (with 3 additional questions in 2021, related to the progress of the MAPEX initiative and the priority lines to follow). A comparative analysis of results was carried out at the national level and by regions in Spain. RESULTS 141 hospitals participated in 2016 and 138 in 2021, with representation from the 17 autonomous communities. The analysis of the results shows significant improvements in all the dimensions of the survey, with variability between the different regions. Among the most important improvements, the development and consolidation of telepharmacy stood out, the greater specialization of pharmacists by areas of knowledge and their integration into multidisciplinary teams. The improvement of the healthcare model was considered the greatest advance at a general level (65%), and remote pharmaceutical care at the hospital level (48.2%). Priority lines of work were considered the expansion and practical application of the pharmaceutical care methodology (66.4%), research (58.4%), and training in all MAPEX initiatives (53.3%). CONCLUSIONS The implementation and development of the MAPEX initiatives has had a positive impact on the evolution in all healthcare areas of pharmaceutical care for outpatients. The situation survey makes it possible to identify by regions the significant points for improvement, as well as those areas to be developed through strengthening and corrective actions. The expansion of the project in the coming years will mean progress towards excellence in care and in the improvement of health results.
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Affiliation(s)
| | | | - Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Osi Barrualde Galdakao, España
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Morillo Verdugo R, Vicente Escrig E, Murillo Izquierdo M, Ibarra Barrueta O, Taberner Bonastre P, Fernández-Llamazares CM. [Analysis of the evolution of outpatient pharmaceutical care in hospital pharmacy services in Spain after the implementation and development of the MAPEX initiative]. J Healthc Qual Res 2024; 39:65-79. [PMID: 38160121 DOI: 10.1016/j.jhqr.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION AND OBJECTIVE In 2015, the Spanish Society of Hospital Pharmacy (SEFH) launched the Strategic Map for Outpatient Pharmaceutical Care (MAPEX), with the purpose of adapting the activity offered in Hospital Pharmacy outpatient clinics to the new healthcare context. The aim of the present study was to analyse the evolution of outpatient pharmaceutical care in Hospital Pharmacy Services in Spain in the period 2016-2021 after the implementation and development of the MAPEX initiative. MATERIAL AND METHOD The implementation and development of the project was carried out by a group of experts from SEFH and consisted of five phases: creation of the structure, consensus conference, situation analysis, development of strategic initiatives and evolutionary analysis. To analyse the evolutionary development, a specific 43-item questionnaire was developed that addressed aspects related to structure, context, integration, processes, outcomes and research and was answered in 2016 and 2021 (in the latter case by adding 3 additional questions). RESULTS 141 hospitals participated in the status survey in 2016 and 138 in 2021. Significant differences were found in all dimensions analysed. None of the aspects assessed suffered a setback in this period. The most highly rated aspects at the general level were the improvement of the care model (65.0%) and at the local level, the incorporation of non-face-to-face pharmaceutical care (42.8%). Further progress in the coming years in the expansion and practical application of the methodology proposed in the project was considered a priority. CONCLUSIONS The implementation and development of the MAPEX initiative has had a positive impact in terms of quality of care for outpatient pharmaceutical care in Hospital Pharmacy services in Spain.
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Affiliation(s)
| | - E Vicente Escrig
- Servicio de Farmacia, Hospital General Universitario de Castellón, Castellón, España
| | - M Murillo Izquierdo
- Servicio de Farmacia, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - O Ibarra Barrueta
- Servicio de Farmacia, Hospital Galdakao-Usansolo. OSI Barrualde, Galdakao, Bizkaia, España
| | - P Taberner Bonastre
- Servicio de Farmacia, Hospital Universitari Arnau de Vilanova, Lleida, España
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Bouchlarhem A, Bazid Z, Ismaili N, El Ouafi N. Cardiac intensive care unit: where we are in 2023. Front Cardiovasc Med 2023; 10:1201414. [PMID: 38075954 PMCID: PMC10704904 DOI: 10.3389/fcvm.2023.1201414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024] Open
Abstract
Cardiac intensive care has been a constantly evolving area of research and innovation since the beginning of the 21st century. The story began in 1961 with Desmond Julian's pioneering creation of a coronary intensive care unit to improve the prognosis of patients with myocardial infarction, considered the major cause of death in the world. These units have continued to progress over time, with the introduction of new therapeutic means such as fibrinolysis, invasive hemodynamic monitoring using the Swan-Ganz catheter, and mechanical circulatory assistance, with significant advances in percutaneous interventional coronary and structural procedures. Since acute cardiovascular disease is not limited to the management of acute coronary syndromes and includes other emergencies such as severe arrhythmias, acute heart failure, cardiogenic shock, high-risk pulmonary embolism, severe conduction disorders, and post-implantation monitoring of percutaneous valves, as well as other non-cardiac emergencies, such as septic shock, severe respiratory failure, severe renal failure and the management of cardiac arrest after resuscitation, the conversion of coronary intensive care units into cardiac intensive care units represented an important priority. Today, the cardiac intensive care units (CICU) concept is widely adopted by most healthcare systems, whatever the country's level of development. The main aim of these units remains to improve the overall morbidity and mortality of acute cardiovascular diseases, but also to manage other non-cardiac disorders, such as sepsis and respiratory failure. This diversity of tasks and responsibilities has enabled us to classify these CICUs according to several levels, depending on a variety of parameters, principally the level of care delivered, the staff assigned, the equipment and technologies available, the type of research projects carried out, and the type of connections and networking developed. The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have detailed this organization in guidelines published initially in 2005 and updated in 2018, with the aim of harmonizing the structure, organization, and care offered by the various CICUs. In this state-of-the-art report, we review the history of the CICUs from the creation of the very first unit in 1968 to the discussion of their current perspectives, with the main objective of knowing what the CICUs will have become by 2023.
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Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
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Miller DR, Reisman JI, McDannold SE, Kleinberg F, Gillespie C, Zogas A, Ndiwane N, Ourth HL, Morreale AP, Tran M, McCullough MB. Clinical pharmacist practitioners on primary care teams play an important role in caring for complex patients with diabetes. Am J Health Syst Pharm 2023; 80:1637-1649. [PMID: 37566141 DOI: 10.1093/ajhp/zxad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE To evaluate whether clinical pharmacist practitioners (CPPs) are being utilized to care for patients with complex medication regimens and multiple chronic illnesses, we compared the clinical complexity of diabetes patients referred to CPPs in team primary care and those in care by other team providers (OTPs). METHODS In this cross-sectional comparison of patients with diabetes in the US Department of Veterans Affairs (VA) healthcare system in the 2017-2019 period, patient complexity was based on clinical factors likely to indicate need for more time and resources in medication and disease state management. These factors include insulin prescriptions; use of 3 or more other diabetes medication classes; use of 6 or more other medication classes; 5 or more vascular complications; metabolic complications; 8 or more other complex chronic conditions; chronic kidney disease stage 3b or higher; glycated hemoglobin level of ≥10%; and medication regime nonadherence. RESULTS Patients with diabetes referred to one of 110 CPPs for care (n = 12,728) scored substantially higher (P < 0.001) than patients with diabetes in care with one of 544 OTPs (n = 81,183) on every complexity measure, even after adjustment for age, sex, race, and marital status. Based on composite summary scores, the likelihood of complexity was 3.42 (interquartile range, 3.25-3.60) times higher for those in ongoing CPP care (ie, those with 2 or more visits) versus OTP care. Patients in CPP care also were, on average, younger, more obese, and had more prior outpatient visits and hospital stays. CONCLUSION The greater complexity of patients with diabetes seen by CPPs in primary care suggests that CPPs are providing valuable services in comprehensive medication and disease management of complex patients.
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Affiliation(s)
- Donald R Miller
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, MA, USA
| | - Joel I Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Sarah E McDannold
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Felicia Kleinberg
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Ndindam Ndiwane
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Heather L Ourth
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Anthony P Morreale
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Michael Tran
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Megan B McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Zuckerberg School of Health Sciences, Department of Public Health, University of Massachusetts, Lowell, MA, USA
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Sikora A. Critical Care Pharmacists: A Focus on Horizons. Crit Care Clin 2023; 39:503-527. [PMID: 37230553 DOI: 10.1016/j.ccc.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Critical care pharmacy has evolved rapidly over the last 50 years to keep pace with the rapid technological and knowledge advances that have characterized critical care medicine. The modern-day critical care pharmacist is a highly trained individual well suited for the interprofessional team-based care that critical illness necessitates. Critical care pharmacists improve patient-centered outcomes and reduce health care costs through three domains: direct patient care, indirect patient care, and professional service. Optimizing workload of critical care pharmacists, similar to the professions of medicine and nursing, is a key next step for using evidence-based medicine to improve patient-centered outcomes.
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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 120 15th Street, HM-118, Augusta, GA 30912, USA; Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
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Wen Y, Zhao M, Fu S, Gu Z, Chen W, Zhao Q, Shu W, Tao X, Zhang F. Pharmaceutical services based on therapeutic care pathway for kidney transplantation from donors of infants and young children: a single-center experience. Transl Pediatr 2022; 11:834-847. [PMID: 35800269 PMCID: PMC9253932 DOI: 10.21037/tp-21-515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The pharmaceutical services based on therapeutic care pathway for kidney transplantation from infants and young children (age <3 years, weight <15 kg) to pediatric recipients can detect and resolve medication-related problems. In this paper, we report our experience on pharmaceutical services based on therapeutic care pathway to evaluate the therapeutic effects and assess the feasibility of perioperative treatment protocols. METHODS We performed a retrospective study of 12 recipients who received their graft from infants and young children, between September 2011 and December 2013 at our institution. As providers of pharmaceutical services, the clinical pharmacists collected and reviewed the clinical data from all patients, including the clinical characteristics, outcome indices, and follow-up dates. A three-step-protocol of pharmaceutical services including clinician's application, pharmacist consultation, and ongoing direct pharmaceutical care and follow-up was used through the entire length of patient's admission, hospitalization, and discharge. This protocol was developed and refined based on the guidelines for transplant perioperative treatment and experiences of the clinical pharmacists to standardize the workflow, and improve the medical treatment and quality of life of patients. RESULTS There was no acute rejection, graft loss, or death in 10 recipients after transplantation, and another 2 received nephrectomy due to dysfunction. Postoperative follow-up of the patients who received the pharmaceutical services from the clinical pharmacist showed an effectiveness in managing medication-related complications, patient-related factors, and an improvement of the outcomes. CONCLUSIONS The three-step protocol of pharmaceutical services for pharmaceutical care and individual dosing regimen sponsored by pharmacists facilitated access to personalized therapies for children undergoing kidney transplantation in our hospital.
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Affiliation(s)
- Yan Wen
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Mengpei Zhao
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Shangxi Fu
- Department of Organ Transplantation, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhichun Gu
- Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wansheng Chen
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Qing Zhao
- Department of Pharmacy, Zhabei Central Hospital of Jing'an District, Shanghai, China
| | - Wei Shu
- Department of Pharmacy, Zhabei Central Hospital of Jing'an District, Shanghai, China
| | - Xia Tao
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Feng Zhang
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
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Altyar A, Sadoun SA, Aljohani SS, Alradadi RS. Evaluating Pharmacy Practice in Hospital Settings in Jeddah City, Saudi Arabia: Dispensing and Administration-2019. Hosp Pharm 2022; 57:32-37. [PMID: 35521022 PMCID: PMC9065526 DOI: 10.1177/0018578720970470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: To evaluate the dispensing and administration processes in hospital settings in Jeddah city, Saudi Arabia. Method: A questionnaire based on the annual ASHP national survey was distributed among 35 hospitals. The response rate was 60%. After a follow-up period of 6 months, the final questionnaire was collected in November 2019. Result: The survey had a 60% response rate. Most surveyed hospitals have centralized pharmacies (76.2%). Few hospitals reported the use of the Bar Code Medication Administration BCMA system (19.0%) to verify doses during dispensing, and only 28.6% use automated dispensing cabinets. The main method to check unit doses in pharmacies is the "technician fills/pharmacist checks" method, as reported by 76.2% of hospitals. Conclusion: The new technologies in the field of healthcare are impacting the practice of medication distribution. Hospital pharmacies in Jeddah, Saudi Arabia are implementing many changes to improve the medication-use system. However, more work has to be done to follow the leaders in the area of pharmacy practice.
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Affiliation(s)
- Ahmed Altyar
- King Abdulaziz University, Jeddah, Saudi Arabia,Ahmed Altyar, Faculty of Pharmacy, King Abdulaziz University, P.O. Box 80260, Jeddah 21441, Saudi Arabia.
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Odeh M, Alkhader E, McCloskey A, Aljabra R, Al-sharayri M, Al-Noimi F, Alarmooti M, Alzu’bi M. Postgraduate pharmacist development- an evaluation of Jordanian pharmacist experiences to inform and shape an evidence-based professional development policy. PLoS One 2021; 16:e0255026. [PMID: 34314444 PMCID: PMC8315534 DOI: 10.1371/journal.pone.0255026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
Building capacity for developing skills as leadership, teamwork, and continuous academic support has become essential for fulfilling a successful pharmacy career. This study aims to assess Jordanian pharmacists' views on professional development, namely: the continuous education infrastructure, strategies and programs for personal development, leadership skills, incentive schemes, drug information resources and digital services. As well as exploring options for better academic support delivered to pharmacists. To capture participant's views, an online validated and reliable survey was developed. Non-probability sampling design was used. Participants were qualified pharmacists working at Royal Medical Services (RMS) and Community Pharmacists (CP). Comparison and descriptive statistics were used to report the results. A total of 271 pharmacists participated, 144 from RMS (8% more than the needed sample) and 127 CP (7% more than the needed sample). There was a strong desire amongst both RMS and PC groups for continuous educational training particularly in the following areas, first: Advanced counselling and communication skills (means = 8.99±0.145, CI 95% = 3.70-4.28 and 9.37±0.096, CI 95% = 4.18-4.56). Second: Personal development skills (mean = 8.92±0.142, CI 95% = 3.64-4.20 and 9.02±0.145, CI 95% = 3.73-4.30). Third, Pharmaceutical health promotion (mean = 8.05±0.180, CI 95% = 2.70-3.41 and 8.57±0.159, CI 95% = 3.26-3.89). Only 19.4% and 18.1% of the RMS and CPs respectively reported the presence of a written policy for personal development and leadership in their workplace. There were few incentives for pharmacists to participate in research. Few pharmacists used the available drug information and toxicology centers. The professional and continuous personal development of pharmacists support an evolving healthcare system. This study emphasizes the need for a tailored and documented postgraduate educational strategy, personal development, and leadership skills training in Jordan. Implementing a well-defined scheme of incentives should be encouraged to engage pharmacists in continuous professional development programs and pharmaceutical research. Such strategy and training should enhance both professional and personal performance.
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Affiliation(s)
- Mohanad Odeh
- Department of Clinical Pharmacy and Pharmacy Practice, Pharmacy Management and Pharmaceutical Care Innovation Centre, Pharmacy School, Hashemite University, Zarqa, Jordan
| | - Enas Alkhader
- Pharmacy School, Middle East University, Amman, Jordan
| | - Alice McCloskey
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Abstract
OBJECTIVES To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. DESIGN The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.
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Singh-Franco D, Mastropietro DR, Metzner M, Dressler MD, Fares A, Johnson M, De La Rosa D, Wolowich WR. Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis. PLoS One 2020; 15:e0243134. [PMID: 33270710 PMCID: PMC7714117 DOI: 10.1371/journal.pone.0243134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST). Methods To identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review. Results Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%). Conclusion This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.
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Affiliation(s)
- Devada Singh-Franco
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
- * E-mail:
| | - David R. Mastropietro
- Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Miriam Metzner
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
| | - Michael D. Dressler
- Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Amneh Fares
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
| | - Melinda Johnson
- Martin and Gail Press Health Professions Division Library, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Daisy De La Rosa
- Martin and Gail Press Health Professions Division Library, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - William R. Wolowich
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, United States of America
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Moore GD, Burns AL, Fish H, Gandhi N, Kebodeaux C, Meny LM, Policastri A, Sneed KB, Traynor A, Vosooney A, Bradley-Baker LR. The Report of the 2019-2020 Professional Affairs Standing Committee: Pharmacist Integration with Primary Care Practices. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:ajpe8199. [PMID: 33149338 PMCID: PMC7596612 DOI: 10.5688/ajpe8199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The 2019-2020 Professional Affairs Committee was charged to (1) Describe the leadership role of schools of pharmacy in advancing interprofessional practice, with an emphasis on physician-pharmacist collaborative relationships; (2) Establish an inventory of resources that can support school efforts to grow collaborative partnerships between pharmacists and physicians; (3) Determine gaps that exist in the resources required to support schools in efforts to facilitate expansion of interprofessional partnerships; and (4) Define strategies and draft an action plan for AACP's role in facilitating member school efforts to accelerate the development of interprofessional practices within their geography of influence. This report provides information on the committee's process to address the committee charges as well as background and resources pertaining to the charges, describes the rationale for and the results from the focus groups conducted at the 2020 AACP Interim Meeting, communicates the results of an initial inventory of models that integrate pharmacists with primary care practices, and provides an overview on issues to continue the work to integrate pharmacists with primary care practices. The committee offered several revisions to current association policy statements and provided a proposed policy statement and several recommendations to AACP pertaining to the committee charges.
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Affiliation(s)
- Gina D Moore
- University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, Colorado
| | - Anne L Burns
- American Pharmacists Association, Washington, District of Columbia
| | - Hannah Fish
- National Community Pharmacists Association, Alexandria, Virginia
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Clark Kebodeaux
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | - Lisa M Meny
- Ferris State University, College of Pharmacy, Grand Rapids, Michigan
| | - Anne Policastri
- American Society of Health-System Pharmacists, Bethesda, Maryland
| | - Kevin B Sneed
- University of South Florida, College of Pharmacy, Tampa, Florida
| | - Andy Traynor
- Concordia University of Wisconsin, School of Pharmacy, Mequon, Wisconsin
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Muñoz‐Pichuante D, Villa‐Zapata L. Benefit of Incorporating Clinical Pharmacists in an Adult Intensive Care Unit: A Cost‐saving Study. J Clin Pharm Ther 2020; 45:1127-1133. [DOI: 10.1111/jcpt.13195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel Muñoz‐Pichuante
- Facultad de Ciencias Instituto de Farmacia Universidad Austral de Chile Valdivia Chile
- Unidad de Cuidados Intensivos Hospital Base de Valdivia Valdivia Chile
| | - Lorenzo Villa‐Zapata
- Center for Pharmaceutical Outcomes Research Skaggs School of Pharmacy & Pharmaceutical Sciences University of Colorado Denver CO USA
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Richards J, Wascher M, Alwan M, Beardsley J, Naseman R, Nesbit T, Trujillo T, Fuller P. State of Privileging in Pharmacy: A Survey of Vizient-Affiliated Institutions. Hosp Pharm 2019; 54:365-370. [PMID: 31762483 DOI: 10.1177/0018578718802831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The process of privileging pharmacists is an important step in developing optimal pharmacy practice models. Currently, little published literature exists detailing the status of pharmacist privileging efforts. The objective of this study is to assess and characterize a snapshot of the current and future state of privileging practices in pharmacy at Vizient academic medical centers (AMCs) and their affiliate institutions. Methods: An electronic survey questionnaire was sent to Vizient pharmacy directors and their affiliates to assess institutional privileging practices and identify perceived or actual barriers. The survey was divided into 2 pathways based on the current status of privileging at the institution. Results: In total, 46 directors of pharmacy completed the survey. Only 33% (15/46) of pharmacy directors indicated they had a current privileging process in place. About 70% (21/30) of institutions without an established privileging process indicated they were considering establishing a process. For institutions without an established privileging process, most pharmacy directors identified a lack of organizational support and resources as barriers to implementation. Conclusion: Although credentialing and privileging is considered a national priority to aid in expanding and enhancing pharmacists' scope of practice, our survey demonstrated that few respondents currently have a privileging process in place. The results from this study may highlight important barriers and keys to success to be considered when implementing a privileging process.
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Affiliation(s)
| | | | - Michael Alwan
- Northwest Hospital & Medical Center-UW Medicine, Seattle, WA, USA
| | | | | | - Todd Nesbit
- The Johns Hopkins Hospital, Baltimore, MD, USA
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Smith MA, Blanchard CM, Vuernick E. The Intersection of Implementation Science and Pharmacy Practice Transformation. Ann Pharmacother 2019; 54:75-81. [DOI: 10.1177/1060028019867253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Marie A. Smith
- University of Connecticut School of Pharmacy, Storrs, CT, USA
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16
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Darby AB, Su Y, Reynolds RB, Madlock-Brown C. A Survey-based Study of Pharmacist Acceptance and Resistance to Health Information Technology. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2019; 16:1a. [PMID: 31019433 PMCID: PMC6462883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Because user acceptance and resistance to the use of health information technology (HIT) affects system utilization and previous studies in this area have typically excluded pharmacists, this study specifically addresses the response of institutional pharmacists to HIT. METHODS A survey investigating pharmacists' responses to electronic medical record (EMR) system use was developed using questions modified from previously validated research. The survey was distributed electronically to the mailing list for pharmacy preceptors for the University of Tennessee College of Pharmacy. Descriptive statistics and univariate and multivariate analyses were used to analyze the collected data based on a previously validated dual-factor model. RESULTS Of the 96 responses from institutional pharmacists, 64 responses (66.7 percent) were complete and usable. Of the acceptance and resistance constructs evaluated, only attitude and perceived behavior control were found to be significantly associated with acceptance of use (p = .036 and p = .025, respectively), and only transition cost was found to be significantly associated with resistance to use (p = .018). System vendor and interface integration were also significantly associated with acceptance of use. These findings suggest that attitude, perceived behavior control, and transition costs may have the most impact on pharmacists' responses to the use of EMR systems. CONCLUSION It is reasonable for hospitals to focus efforts on specific factors influencing acceptance of and resistance to EMR use and, before a system is selected, to consider the effects of vendor selection and level of interface integration on acceptance of use.
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Affiliation(s)
| | - Yin Su
- The University of Tennessee Health Science Center in Memphis, TN
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17
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Smith ZR, Rangarajan K, Barrow J, Carter D, Coons JC, Dzierba AL, Falvey J, Fester KA, Guido MR, Hao D, Ou NN, Pogue KT, MacDonald NC. Development of best practice recommendations for the safe use of pulmonary hypertension pharmacotherapies using a modified Delphi method. Am J Health Syst Pharm 2019; 76:153-165. [DOI: 10.1093/ajhp/zxy020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zachary R Smith
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan
| | | | - Jennifer Barrow
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC
| | - Danielle Carter
- Department of Pharmacy Services, Brigham & Women’s Hospital, Boston, MA
| | - James C Coons
- Department of Pharmacy, UPMC Presbyterian Hospital, Pittsburgh, PA, and University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | - Amy L Dzierba
- Department of Pharmacy, New York-Presbyterian Hospital, New York, NY
| | - Jennifer Falvey
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY
| | - Keith A Fester
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO
| | - Maria R Guido
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH
| | - Diana Hao
- Department of Pharmacy Services, UC Davis Medical Center, Sacramento, CA
| | - Narith N Ou
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | - Kristen T Pogue
- Department of Pharmacy, University of Michigan Hospitals and Health Centers, Ann Arbor, MI
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18
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Shalansky S. The Advanced Pharmacist Practitioner: A New Series in the Canadian Journal of Hospital Pharmacy. Can J Hosp Pharm 2019; 72:42-48. [PMID: 30828093 PMCID: PMC6391237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stephen Shalansky
- , BSc(Pharm), ACPR, PharmD, FCSHP, is Clinical Coordinator with the Pharmacy Department, Providence Healthcare, Lower Mainland Pharmacy Services, and Clinical Professor with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia. He is also the Editor of the Canadian Journal of Hospital Pharmacy
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19
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Vest TA, Carrasquillo MA, Morbitzer KA, Cruz JL, Eckel SF. Evaluation of a comprehensive, integrated, medical service-based pharmacy practice model. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tyler A. Vest
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
| | - Michelle A. Carrasquillo
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
| | - Kathryn A. Morbitzer
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
| | - Jennifer L. Cruz
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
| | - Stephen F. Eckel
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
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20
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Flynn A, Mo H, Nguyen JV, Chaffee BW. Initial study of clinical pharmacy work prioritization tools. Am J Health Syst Pharm 2018; 75:1122-1131. [DOI: 10.2146/ajhp170398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Allen Flynn
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | | | - Jerika V. Nguyen
- Department of Pharmacy Services, Oregon Health and Science University Hospital, Portland, OR
| | - Bruce W. Chaffee
- Department of Pharmacy, Michigan Medicine, College of Pharmacy, University of Michigan, Ann Arbor, MI
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21
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Potter LM, Tichy EM, Horwedel TA, Shullo MA, Ensor CR, Pilch NA, Cochrane AB, Maldonado AQ, Jacobi J, Sam T. Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice: An Alternative Viewpoint. Pharmacotherapy 2016; 36:e195-e197. [PMID: 27714823 DOI: 10.1002/phar.1844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lisa M Potter
- Department of Pharmacy Services, University of Chicago Medicine, Chicago, Illinois
| | - Eric M Tichy
- Department of Pharmacy, Yale-New Haven Hospital, New Haven, Connecticut
| | | | - Michael A Shullo
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher R Ensor
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicole A Pilch
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina
| | - Adam B Cochrane
- Department of Pharmacy, Inova Fairfax Hospital, Falls Church, Virginia
| | - Angela Q Maldonado
- Department of Transplant Surgery, Vidant Medical Center, Greenville, North Carolina
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22
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Haas CE, Haase KK. Pharmacy Practice Model Initiative-It's All About Implementation. Pharmacotherapy 2016; 36:576-8. [DOI: 10.1002/phar.1743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Curtis E. Haas
- Department of Pharmacy; University of Rochester Medical Center; Rochester New York
| | - Krystal K. Haase
- School of Pharmacy; Texas Tech University Health Sciences Center; Amarillo Texas
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