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Looney B, Crumb J, White S, Jones G, Moore RP, Choi L, Zuckerman AD, Whelchel K. Financial impact of integrated specialty pharmacy efforts to avoid oral anticancer medication waste. J Manag Care Spec Pharm 2024; 30:465-474. [PMID: 38701029 PMCID: PMC11068656 DOI: 10.18553/jmcp.2024.30.5.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND The growing number of oral anticancer medications represents a significant portion of pharmacy spending and can be costly for patients. Patients taking oral anticancer medications may experience frequent treatment changes following necessary safety and effectiveness monitoring, often resulting in medication waste. Strategies to avoid medication waste could alleviate the financial burden of these costly therapies on the payer and the patient. OBJECTIVE To evaluate the impact on waste and cost avoidance of reviewing the amount of medication patients have on hand and the presence of upcoming follow-up (ie, provider visit, laboratory testing, or imaging) before requesting a prescription refill renewal for patients taking oral anticancer medications through an integrated health system specialty pharmacy. METHODS We performed a retrospective review of patients filling oral anticancer medications prescribed by a Vanderbilt University Medical Center provider and dispensed by Vanderbilt Specialty Pharmacy between January 1, 2020, and December 31, 2020. Specialty pharmacists received a system-generated refill renewal request for oral anticancer medications when the final prescription refill was dispensed, prompting the pharmacist to review the patient's medical record for continued therapy appropriateness and to request a new prescription. If the patient had a sufficient supply on hand to last until an upcoming follow-up (ie, provider visit, imaging, or laboratory assessment), the pharmacist postponed the renewal until after the scheduled follow-up. Patients were included in the analysis if the refill renewal request was postponed after review of the amount of medication on hand and the presence of an upcoming follow-up. Medication outcomes (ie, continued, dose changed, held, medication changed to a different oral anticancer medication, or discontinued) resulting from the follow-up were collected. Cost avoidance in US dollars was assigned based on the outcome of follow-up by calculating the price per unit times the number of units that would have been unused or in excess of what was needed if the medication had been dispensed before the scheduled follow-up. The average wholesale price minus 20% (AWP-20%) and wholesale acquisition cost (WAC) were used to report a range of costs avoided over 12 months. RESULTS The total cost avoidance over 12 months associated with postponing refill renewal requests in a large academic health system with an integrated specialty pharmacy ranged from $549,187.03 using WAC pricing to $751,994.99 using AWP-20% pricing, with a median cost avoidance per fill of $366.04 (WAC) to $1,931.18 (AWP-20%). Refill renewal requests were postponed in 159 instances for 135 unique patients. After follow-up, medications were continued unchanged in only 2% of postponed renewals, 56% of follow-ups resulted in medication discontinuations, 32% in dose changes, 5% in medication changes, and 5% in medication holds. CONCLUSIONS Integrated health system specialty pharmacist postponement of refill requests after review of the amount of medication on hand and upcoming follow-up proved effective in avoiding waste and unnecessary medication costs in patients treated with oral anticancer medications at a large academic health system.
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Affiliation(s)
- Brooke Looney
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN
| | - Jared Crumb
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN
| | - Stephanie White
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN
| | | | - Ryan P. Moore
- Department of Biostatistics, Vanderbilt Health System, Nashville, TN
| | - Leena Choi
- Department of Biostatistics, Vanderbilt Health System, Nashville, TN
| | | | - Kristen Whelchel
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN
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Leite-Costa T, Rodrigues D, Sá F, Cruz Correia R. Time optimization in primary care - chronic prescription cost. BMC Health Serv Res 2023; 23:454. [PMID: 37158887 PMCID: PMC10166022 DOI: 10.1186/s12913-023-09355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Time optimization is a common goal to most health information institutions. In several countries, chronic electronic renewal prescriptions were one of the main focuses when implementing information systems. In Portugal, Electronic Medical Prescription (PEM®) software is used for most electronic prescriptions. This study aims to quantify the time spent in chronic prescription renewal appointments (CPRA) in primary care and its impact in the Portuguese National Health System (SNS). METHODS Eight general practitioners (GP) were included in the study during February 2022. The average duration of 100 CPRA was obtained. To determine the number of CPRA performed every year, a primary care BI-CSP® platform was used. Using Standard Cost Model and average medical doctor hourly rate in Portugal we estimated CPRA global costs. RESULTS Each doctor spent on average 1:55 ± 01:07 min per CPRA. There were 8295 GP working in 2022. A total 635 561 CPRA were performed in 2020 and 774 346 in 2021. In 2020, CPRA costs ranged 303 088 ± 179 419€, and in 2021 that number increased to 369 272 ± 218 599€. CONCLUSION This is the first study to quantify CPRA's real cost in Portugal. A PEM® software update would allow daily savings, ranging from 830€ (± 491€) in 2020 and 1011€ (± 598€) in 2021. That change could allow hiring 8 ± 5 GP in 2020 and 12 ± 7 in 2021.
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Affiliation(s)
- Tiffany Leite-Costa
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal.
- USF Covelo, ACeS Porto Oriental, Porto, Portugal.
| | - Daniel Rodrigues
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
| | - Fernando Sá
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
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Oke I, Badami A, Kosteva KL, Wu K, Desai M. Systemic Barriers in Receiving Electronically Prescribed Glaucoma Medications. J Glaucoma 2022; 31:812-815. [PMID: 35980860 PMCID: PMC9530008 DOI: 10.1097/ijg.0000000000002100] [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: 04/21/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Over a third of electronically prescribed glaucoma medications were not picked up within 1 month of patient request. Feedback-driven protocols may help minimize treatment interruptions attributed to electronic prescribing. PURPOSE Glaucoma treatment relies on long-term medication compliance and many socioeconomic factors impact the ability of patients to receive their medications. This study aims to quantify treatment interruptions attributable to electronically prescribed medications and propose interventions to minimize this barrier. METHODS This is a cross-sectional study of the electronic prescribing patterns at a tertiary care hospital serving a socioeconomically diverse patient population. Glaucoma medication refill requests received over a 6-week interval were reviewed and patient pharmacies were contacted 1 month after the request date to determine whether the medication was received by the patient. Patients who did not pick up the prescriptions were contacted and consented to participate in a survey to identify the barriers to acquiring the medications. RESULTS Refill requests of 198 glaucoma medications met the inclusion criteria and the most common classes were prostaglandin analogs (44%) and alpha-2-agonists (21%). Medications were not obtained within 1 month in 71 (35.9%) cases. Prior authorization requirement was significantly associated with patients not obtaining their medication (odds ratio, 0.07; 95% confidence interval, 0.03-0.45). Patient reported challenges to successful receipt electronically prescribed medications included insurance coverage (32.2%) and pharmacy availability (22.6%). CONCLUSIONS Approximately a third of electronically prescribed glaucoma medications were not received by patients within a month of refill request due to the need for prior authorization, insurance coverage, and pharmacy availability. A mechanism to alert providers and to address these barriers to medication access may minimize treatment interruption and disease progression.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Medical Center, Boston MA
- Department of Ophthalmology, Boston Children’s Hospital, Boston MA
| | - Avni Badami
- Department of Ophthalmology, Boston Medical Center, Boston MA
| | | | - Kevin Wu
- Department of Ophthalmology, Boston Medical Center, Boston MA
| | - Manishi Desai
- Department of Ophthalmology, Boston Medical Center, Boston MA
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Nikander K, Kosola S, Vahlberg T, Kaila M, Hermanson E. Associating school doctor interventions with the benefit of the health check: an observational study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001394. [PMID: 36053658 PMCID: PMC8889353 DOI: 10.1136/bmjpo-2021-001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks. METHODS Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression. RESULTS Doctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91-17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit. CONCLUSIONS Doctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor. TRIAL REGISTRATION NUMBER NCT03178331.
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Affiliation(s)
- Kirsi Nikander
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland .,School and Student Healthcare, Department of Social Services and Healthcare, City of Helsinki, Helsinki, Finland.,Doctoral School in Health Sciences, Doctoral Program in Population Health, University of Helsinki, Helsinki, Finland
| | - Silja Kosola
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero Vahlberg
- Faculty of Medicine, Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Minna Kaila
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Elina Hermanson
- Pikkujätti Medical Center for Children and Youth, Helsinki, Finland
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Prudencio J, Kim M. Prescription Renewal Request Reviews by Student Pharmacists in a Family Medicine Clinic. PHARMACY 2021; 9:pharmacy9040197. [PMID: 34941629 PMCID: PMC8705355 DOI: 10.3390/pharmacy9040197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Prescription renewal requests were reviewed by student pharmacists on advanced pharmacy practice experiences (APPE) at a primary care and family medicine clinic. Student pharmacists reviewed requests and triaged them to the respective primary care provider (PCP), along with any recommendations to optimize the medication regimen. This study aims to assess the acceptance of these recommendations as well as the student’s perception of this activity as a learning tool. A total of 35 4th-year pharmacy students participated in this activity during APPE rotations from May 2019 to March 2021. A total of 184 recommendations were made, with 128 (70%) being accepted by PCPs. Based on a post-rotation anonymous survey, students reported high levels of agreeance that this activity had a positive impact on their education in a variety of ways. This prescription renewal request review process has been shown to have a positive impact on patient care and clinic workflow while also providing pharmacy students with a helpful educational activity.
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Alghadeer S, Althunayan SF, Alghamdi BM, Bintaleb D, Alnaim L. Evaluation and pharmacists perspective of repeat prescribing process in refill clinics. Saudi Pharm J 2021; 29:1336-1342. [PMID: 34819794 PMCID: PMC8596148 DOI: 10.1016/j.jsps.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/16/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Repeat prescription refers to a re-prescribed medications list issued by a refill clinic, commonly for stable chronic illnesses. The issues regarding repeat prescriptions have garnered increasing important in recent years, as no general agreement about a standardized protocol exists between organizations. Due to the importance of pharmacists’ involvement and intervention in the process of repeat prescription and the lack of local studies discussing this topic, the aim of this study was to assess pharmacists’ perspectives toward the repeat prescription process and identify the issues related to repeat prescriptions in refill clinics at tertiary hospitals. Methodology A self-developed questionnaire was used to assess outpatient pharmacists’ perspectives toward the repeat prescription process. This was followed by a comprehensive review of the electronic health records (EHR) of patients who requested repeat prescriptions to identify related issues. The study was conducted at a tertiary teaching hospital from September 2019 to January 2020. Results Based on the questionnaire, 34 pharmacists reported receiving less than 10 repeat prescriptions per week (82.35%); nevertheless, around 88.24% of pharmacists have faced issues with the repeat prescription process, and only 15.65% of the issues got resolved. Most of the pharmacists (88.24%) showed a proactive attitude toward modifying the work process to reduce issues. Further, the review of the patients’ EHR identified 1766 prescriptions with related issues in 617 (14.02%) patients’ profiles. Most of these issues were seen in the elderly (46.7%). The most common issue encountered was “Patients came too early to request,” which accounted for 986 (55.8%) of the total issues, followed by the issue of “Refilling a restricted medication” reported at 247 (14%). Only 11% of these issues were completely resolved by pharmacists. Conclusion The repeat prescription service might be associated with issues that lead to preventable adverse effects, especially among the elderly who are prone to such effects. Comprehensive reviews of patients’ profiles are necessary to assess their needs and avoid such issues.
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Affiliation(s)
- Sultan Alghadeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | | | | | - Doaa Bintaleb
- Department of Pharmacy Services, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Lamya Alnaim
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
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Oravainen T, Airaksinen M, Hannula K, Kvarnström K. How Physicians Renew Electronic Prescriptions in Primary Care: Therapeutic Decision or Technical Task? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010937. [PMID: 34682682 PMCID: PMC8536033 DOI: 10.3390/ijerph182010937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
In long-term pharmacotherapies, the renewal of prescriptions is part of the medication use process. Although the majority of medicines are used with renewed prescriptions, little research has focused on renewal practices. The aim of this study was to explore current renewal practices from a primary care physician’s perspective to identify system-based challenges and development needs related to the renewal practices. This qualitative study was conducted in two phases in public primary health care centres of Kirkkonummi, Finland. First, five physicians were shadowed on-site while they renewed prescriptions. The findings of the shadowing phase were further discussed in two focus group discussions with seven other physicians than in the shadowing phase. Inductive content analysis was used for data analysis utilizing Reason’s risk management theory as a theoretical framework. Due to problems in the renewal process, including impractical information systems, a lack of reconciled medication lists, and a lack of time allocated for renewing prescriptions, physicians felt that monitoring and reviewing each patients’ medications for renewal was complicated. Therefore, they felt that renewing, at times, became a technical task rather than a therapeutic decision. The physicians suggested information system improvements, enhanced interprofessional cooperation, and patient involvement as strategies to ensure rational pharmacotherapy and patient safety in the renewal of prescription medicines.
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Affiliation(s)
- Taina Oravainen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (M.A.); (K.K.)
- Correspondence:
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (M.A.); (K.K.)
| | - Kaija Hannula
- Kirkkonummi Health Centre, 02400 Kirkkonummi, Finland;
| | - Kirsi Kvarnström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (M.A.); (K.K.)
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
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