Recommended quality measures for health-system pharmacy: 2019 update from the Pharmacy Accountability Measures Work Group

Scoring big: Aligning inpatient clinical pharmacy services through implementation of an electronic scoring system

PURPOSE

Data are limited on utilizing a comprehensive scoring system in the electronic health record to help prioritize, align, and standardize clinical pharmacy services across multiple hospitals and practice models within a health system. The purpose of this article is to describe the development and implementation of an electronic scoring system to help inpatient pharmacists prioritize patient care activities and standardize clinical services across a diverse health system.

SUMMARY

Inpatient pharmacists from all specialty areas across the health system partnered with health information technology pharmacists to develop a scoring system directly integrated into the electronic health record that would help triage patient care, identify opportunities for pharmacist intervention, and prioritize clinical pharmacy services. Individual variables were built based on documented patient parameters such as use of high-risk medications, pharmacy consults, laboratory values, disease states, and patient acuity. Total overall scores were assigned to patients based on the sum of the scores for the individual variables, which update automatically in real time. The total scores were designed to help inpatient pharmacists prioritize patients with higher scores, thus reducing the need for manual chart review to identify high-risk patients.

CONCLUSION

An electronic scoring system with a tiered point system developed for inpatient pharmacists creates a method to prioritize and align clinical pharmacy services across a health system with diverse pharmacy practice models.

The Role of Adult Vaccines as Part of Antimicrobial Stewardship: A Scoping Review

BACKGROUND

Antimicrobial resistance (AMR) is a significant global health concern, causing an estimated 700,000 deaths annually. Although immunisation has been shown to significantly reduce AMR, the role of vaccines as part of antimicrobial stewardship (AMS) practices is often overlooked.

OBJECTIVE

To identify and examine the available literature on the role of vaccines as part of AMS practices.

METHOD

A scoping review was conducted in the following databases: MEDLINE, Embase, Scopus, CINAHL, CCRCT, IPA, and WoS, along with grey literature sources. The review was conducted using the JBI Methodology for Scoping Reviews and reported in line with the PRISMA-SCr checklist.

RESULTS

Among the 1711 records identified, 34 met the inclusion criteria; 8 discussed only the concept, while 26 discussed both the concept and the vaccine implementation method in AMS practices. There were eight recommended and/or utilised types of AMS activities identified involving vaccines, under four key themes of vaccine-related AMS strategies: Education, Screening, Vaccination, and Monitoring. Influenza and pneumococcal vaccines had the most evidence for inclusion.

CONCLUSION

Overall, the evidence supports the role of vaccines as part of AMS practices and the value of their inclusion in creating improved and comprehensive AMS strategies to further combat the development of AMR.

Superficial and Inkjet Scalable Printed Sensors Integrated with Iron Oxide and Reduced Graphene Oxide for Sensitive Voltammetric Determination of Lurasidone

The present work demonstrated the fabrication and the electrochemical characterization of novel printed electrochemical sensors integrated with an innovative nanosensing platform based on the synergic electrocatalytic effect of iron oxide nanoparticles (FeONPs) and reduced graphene oxide (rGO) for precise voltammetric determination of the antipsychotic drug lurasidone hydrochloride (LUH). The features of the electrode surface fabricated using the ordinary inkjet printer were characterized by scanning electron microscopy and electrochemical impedance spectroscopy. Among different ink formulations, integration of the printing ink with the ratio 15 mg FeONPs and 20 mg rGO was found to be the most appropriate for sensitive quantification of LUH in biological fluids and pharmaceutical formulations in the presence of LUH degradation products. Under the optimized experimental and electroanalytical parameters, the recorded square-wave voltammograms were correlated to LUH within the linear concentration ranging from 50 to 2150 ng mL^-1 with detection limit and limit of quantification values of 15.64 and 47.39 ng mL^-1, respectively. Based on the cyclic voltammograms recorded for LUH at different scan rates, the electrode reaction was assumed to be a diffusion reaction mechanism accompanied by the transfer of two electrons/protons through the oxidation of the five-membered ring nitrogen atom as assumed by the molecular orbital calculations carried out on the LUH molecule. The C _max of LUH and the efficiency of the fabricated sensors enabled their clinical application for monitoring LUH in human biological fluids and pharmaceutical formulations in the presence of degradants for diverse quality control applications and green chemistry analysis.

Development of a value-based care and population health internship for student pharmacists

INTRODUCTION

Pharmacists assist in achieving desired outcomes and reducing costs of care within newer value-based payment models. The purpose of this article is to describe a summer internship for first- and second-year student pharmacists to gain exposure to value-based care.

METHODS

University Health Network is a clinically integrated health network and accountable care organization in East Tennessee. Two student interns completed consecutive seven-week programs alongside clinical pharmacist specialists in the primary care settings of the network. Program requirements included direct patient care for chronic disease state management, topic discussions, formal writing assignments and presentations, and a quality improvement project. Student perception of internship activities was measured using a Likert type survey and free response questionnaire.

RESULTS

Student interns responded positively to program requirements with feelings of enhanced preparedness for advanced pharmacy practice experiences and post-graduate residency positions. Additionally, interns perceived themselves as more competitive for post-graduate positions having completed the internship.

CONCLUSIONS

As the US continues to move toward value-based payment models, student pharmacists must be well prepared to contribute to quality and population health initiatives. Student pharmacists benefit from an internship in a clinically integrated health network by gaining an improved understanding of the future of United States healthcare, an expanded clinical skillset, experience in demonstrating a pharmacist's value to the healthcare team, and the ability to overcome barriers to pharmacy services. A pharmacy internship within a clinically integrated health network may help prepare students to successfully contribute to value-based models of healthcare.

Changes in clinical markers observed from pharmacist-managed cardiovascular risk reduction clinics in federally qualified health centers: A retrospective cohort study

BACKGROUND

Reductions in hemoglobin A1c (HbA1C) have been associated with improved cardiovascular outcomes and savings in medical expenditures. One public health approach has involved pharmacists within primary care settings. The objective was to assess change in HbA1C from baseline after 3-5 months of follow up in pharmacist-managed cardiovascular risk reduction (CVRR) clinics.

METHODS

This retrospective cohort chart review occurred in eight pharmacist-managed CVRR federally qualified health clinics (FQHC) in Indiana, United States. Data were collected from patients seen by a CVRR pharmacist within the timeframe of January 1, 2015 through February 28, 2020. Data collected include: demographic characteristics and clinical markers between baseline and follow-up. HbA1C from baseline after 3 to 5 months was assessed with pared t-tests analysis. Other clinical variables were assessed and additional analysis were performed at 6-8 months. Additional results are reported between 9 months and 36 months of follow up.

RESULTS

The primary outcome evaluation included 445 patients. Over 36 months of evaluation, 3,803 encounters were described. Compared to baseline, HbA1C was reduced by 1.6% (95%CI -1.8, -1.4, p<0.01) after 3-5 months of CVRR care. Reductions in HbA1C persisted at 6-8 months with a reduction of 1.8% ([95%CI -2.0, -1.5] p<0.01). The follow-up losses were 29.5% at 3-5 months and 93.2% at 33-36 months.

CONCLUSIONS

Our study augments the existing literature by demonstrating the health improvement of pharmacist-managed CVRR clinics. The great proportion of loss to follow-up is a limitation of this study to be considered. Additional studies exploring the expansion of similar models may amplify the public health impact of pharmacist-managed CVRR services in primary care sites.

Implementation of a strategy for identification and monitoring of clinical outcome measures in a department of pharmacy

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

To describe a department of pharmacy strategy to identify and monitor outcome measures that represent the impact of clinical pharmacy services on patient outcomes.

SUMMARY

Our department established the Clinical Impact Committee, with the goal of developing and maintaining an approach to demonstrate the impact of clinical pharmacists on patient care outcomes. We describe the committee's structure, aims, and key stakeholders, inclusive of both departmental leadership and clinical pharmacist representatives across service lines. We also describe the systematic process used by the committee for identifying clinical outcome measures that are both aligned with organizational priorities and representative of pharmacists' impact. This involved assembly of a crosswalk of clinical outcome measures that are prioritized by the organization and attributable to the work of clinical pharmacists. We found it imperative to connect pharmacists' efforts to the priorities of the organization to demonstrate value and continue to justify pharmacy resources. Once the crosswalk of clinical outcome measures was assembled, the Clinical Impact Committee leveraged modified Delphi methodology to build consensus on the measures to prioritize. Once determined, the final outcome measures were developed into outcomes dashboards, to be monitored by the committee and leveraged by frontline pharmacists.

CONCLUSION

Our organization was successful in developing a structure, the Clinical Impact Committee, to identify, prioritize, and monitor measures that demonstrate pharmacist contributions to patient care outcomes. Further, our approach includes an intentional alignment with organizational priorities, allowing us to understand and communicate the contributions of our teams to meeting-defined organizational quality priorities.

Evaluation of the impact of a clinical pharmacist on a specialty neurology clinic's adherence to recommended laboratory test monitoring

BACKGROUND: Pharmacists can have a significant effect on the specialty ambulatory care setting. Specialty medications are potentially high risk and may require frequent laboratory test monitoring to assess for therapy-associated adverse effects. Pharmacists may work under collaborative drug therapy management agreements that allow for the ordering and assessment of recommended laboratory tests in order to optimize safe and effective medication use. The impact of pharmacists on clinic adherence to recommended laboratory test monitoring has yet to be described in the literature. OBJECTIVE: To describe the impact of a specialty clinical pharmacist on neurology clinic adherence to manufacturer-recommended laboratory test monitoring. METHODS: This study was a retrospective chart review at a single academic medical center for the period between July 1, 2014, and April 30, 2020, comparing laboratory test monitoring adherence before (prepharmacist) and after (post-pharmacist) incorporation of a pharmacist into a neurology clinic. Patients were included if they lived in the Tri-County Area of Charleston, South Carolina, and received a prescription for dalfampridine, dimethyl fumarate, fingolimod, teriflunomide, or cannabidiol that was prescribed by a neurology clinic provider at the Medical University of South Carolina. Chart review was conducted to assess clinic adherence with manufacturer-recommended laboratory test monitoring. Laboratory test monitoring was considered adherent if obtained within 6 months before or on the date of prescription order. Descriptive statistics were calculated for all variables, and adherence rates were compared using chi-square or Fisher's exact tests. RESULTS: For dalfampridine, dimethyl fumarate, fingolimod, and teriflunomide, there were 123 patients and 78 patients in the pre- and post-pharmacist groups, respectively. There were 51 patients in the cannabidiol group. Clinic adherence to laboratory test monitoring improved in the post-pharmacist group for every monitoring point, with statistically significant improvement in "hepatic function tests every 6-9 months" (P = 0.005), "CBC every 6-9 months" (P = 0.01), and "VZV IgG titer at baseline" (P = 0.005) for patients taking fingolimod. CONCLUSIONS: Our study demonstrated improved adherence to manufacturer-recommended laboratory test monitoring after a specialty clinical pharmacist was incorporated into a multidisciplinary neurology clinic. DISCLOSURES: No funding supported this study. The authors have nothing to disclose.

The high-value pharmacy enterprise framework: Advancing pharmacy practice in health systems through a consensus-based, strategic approach

Purpose

The high-value pharmacy enterprise (HVPE) framework and constituent best practice consensus statements are presented, and the methods used to develop the framework’s 8 domains are described.

Summary

A panel of pharmacy leaders used an evidence- and expert opinion–based approach to define core and aspirational elements of practice that should be established within contemporary health-system pharmacy enterprises by calendar year 2025. Eight domains of an HVPE were identified: Patient Care Services; Business Services; Ambulatory and Specialty Pharmacy Services; Inpatient Operations; Safety and Quality; Pharmacy Workforce; Information Technology, Data, and Information Management; and Leadership. Phase 1 of the project consisted of the development of draft practice statements, performance elements, and supporting evidence for each domain by panelists, followed by a phase 2 in-person meeting for review and development of consensus for statements and performance elements in each domain. During phase 3, the project cochairs and panelists finalized the domain drafts and incorporated them into a full technical report and this summary report.

Conclusion

The HVPE framework is a strategic roadmap to advance pharmacy practice by ensuring safe, effective, and patient-centered medication management and business practices throughout the health-system pharmacy enterprise. Grounded in evidence and expert recommendations, the statements and associated performance elements can be used to identify strategic priorities to improve patient outcomes and add value within health systems.

Development of a quality measures tool for the utilization of tyrosine kinase inhibitors in non-small cell lung cancer: An integrated specialty pharmacy initiative

BACKGROUND

Tyrosine kinase inhibitors, commonly prescribed for non-small cell lung cancer, are efficacious but pose safety risks that can diminish quality of life. Quality measures to ensure appropriate utilization and monitoring of tyrosine kinase inhibitors are needed to reduce unnecessary healthcare costs and maximize therapeutic benefit. With integrated clinical and pharmaceutical care services, a health-system specialty pharmacy is the ideal setting for quality measures development.

PURPOSE

The purpose of this initiative was to develop a tool to assess quality in the utilization of tyrosine kinase inhibitors in non-small cell lung cancer by engaging multiple key stakeholder perspectives to identify the fundamental elements of high-quality clinical and specialty pharmacy care.

SUMMARY

Quality measures for the utilization of tyrosine kinase inhibitors in non-small cell lung cancer were developed by conducting package insert, guideline, and literature review followed by integrating feedback from key stakeholder groups through individual conversations and a structured assessment. The finalized guide assesses safety, efficacy, persistence, and patient-reported outcomes using defined clinical and specialty pharmacy measures. Most stakeholders agreed that the proposed measures were relevant as well as accurate and expressed support for implementation.

CONCLUSIONS

The proposed tool provides a framework for specialty pharmacies to deliver quality care in the use of tyrosine kinase inhibitors for the treatment of non-small cell lung cancer. Further work is needed to implement and validate this tool.