Search

Prescription opioid misuse remains a significant cause of morbidity and mortality associated with drug overdose. Researchers, government agencies, public health interests, and professional organizations support the benefits of naloxone coprescribing for patients on chronic opioid therapy to prevent deaths from opioid overdose. However, gaps remain in the provision of naloxone to patients at risk. Currently, less than 1% of patients who should be prescribed naloxone with their opioid medications obtain a prescription for naloxone, illustrating an opportunity for health care providers to conduct thorough risk assessments for patients taking opioids and coprescribing naloxone to those at risk. There are documented barriers to the provision of naloxone for primary care providers, pharmacists, and patients. Managed care organizations have also created barriers. To better understand and evaluate trends in treatment, coverage, policies, and needs associated with providing health services to patients with substance use disorders, the Academy of Managed Care Pharmacy (AMCP) Addiction Advisory Group conducted a survey in 2019. Eighty percent of the managed behavioral health organizations and 47% of AMCP payer members who responded to the survey encouraged naloxone coprescribing in patients at high risk of overdose; however, no organizations require coprescribing. Health plans, managed care organizations, prescribers, pharmacists, patients, and others have important roles in decreasing the morbidity and mortality associated with opioid overdose. In particular, managed care organizations can take specific and meaningful actions to implement payment policies that improve naloxone coprescribing for patients at risk. In this article, opportunities have been outlined for managed care leadership that actively support public health policies for naloxone coprescribing, and 7 recommendations are presented.

The establishment of the Sustainable Development Goals in 2015 entails generating relevant and timely statistics for monitoring and policymaking. The Philippine Statistics Authority (PSA) generates poverty statistics using the Family Income and Expenditure Survey (FIES). However, due to certain limitations, the FIES collection and calculation of official poverty statistics is done only every three years. In this regard, this paper presents a method of filling in the gaps by interpolating annual poverty statistics, particularly the poverty incidence, using macroeconomic indicators and demographic and employment information from the Labor Force Survey (LFS). These explanatory variables were related to the poverty incidence using the Dynamic Factor Model (DFM) in the state-space form to produce estimates for years when poverty statistics are not available. Relatively high forecast accuracy was observed for the predicted values of poverty incidence.

With the advancement of technology, digitalization, and the internet of things, large amounts of complex data are being produced daily. This vast quantity of various data produced at high speed is referred to as Big Data. The utilization of Big Data is being implemented with success in the private sector, yet the public sector seems to be falling behind despite the many potentials Big Data has already presented. In this regard, this paper explores ways in which the government can recognize the use of Big Data for official statistics. It begins by gathering and presenting Big Data-related initiatives and projects across the globe for various types and sources of Big Data implemented. Further, this paper discusses the opportunities, challenges, and risks associated with using Big Data, particularly in official statistics. This paper also aims to assess the current utilization of Big Data in the country through focus group discussions and key informant interviews. Based on desk review, discussions, and interviews, the paper then concludes with a proposed framework that provides ways in which Big Data may be utilized by the government to augment official statistics.

Objectives To describe the views of pharmacists and student pharmacists regarding (1) aspects of life and experiences that provide professional and personal satisfaction and fulfillment, (2) causes of stress, and (3) needs related to maintaining satisfaction and fulfillment. Design A generic qualitative research design was used for collecting data from 380 pharmacists and 332 student pharmacists who wrote responses to an online survey hosted by the American Pharmacists Association (APhA) from November 17 to December 2, 2018, using standard data collection procedures applied by that organization. APhA uses its member and affiliate data files as its sampling frame and limits the number of contacts per year for each person in those files. De-identified responses from those who volunteered to write comments were sent to the research team for analysis. A conventional content analysis approach was applied for analysis of the text. Analysts convened to discuss emergent themes and develop operational descriptions. Key segments of text that best represented each theme were identified. Personal presuppositions were disclosed and were useful for developing group consensus for theme identification and description. Rigor was supported through assessment of credibility, confirmability, intercoder checking, transferability, inductive thematic saturation, and authenticity. Setting and participants Participants are in the design since data already collected. Outcome measures Not applicable. Results Findings showed that pharmacists and student pharmacists are able to recognize and pursue achievement, recognition, responsibility, advancement, relationship, esteem, self-actualization, meaning, and accomplishment in both their professional and personal lives. However, external factors such as “workism” and individual factors such as “moral distress” were identified as areas of improvement that are needed for well-being and resilience. Conclusion Pharmacists’ basic human needs are being met, but to improve well-being and resilience for pharmacists in both their professional and personal lives, there is a need for addressing both the external factors and individual factors that they encounter.

Objectives The APhA Stakeholder Conference on Improving Patient Access to Injectable Medications was convened to foster national dialogue to advance the pharmacist's role in the provision of injectable medication administration services (MAS) and related patient care services, and to establish pharmacy as a site of care for these injections. Participants discussed the distinct opportunities to maximize pharmacist scope of services, expand patient access to care, improve medication adherence, and enhance outcomes for patients on injectable medication therapies for a range of conditions. These elements were framed in terms of the practice model, the business model, and the necessary training and resources to support these activities. Data sources National thought leaders within pharmacy practice, pharmacist employers, national pharmacy associations, and pharmaceutical companies were invited to participate in the conference on December 15, 2016. Participants provided perspectives on a series of structured questions around administrative and patient care issues associated with the expansion of pharmacy-based MAS. Outcomes from the discussions were supplemented with related information from the literature. Summary The APhA Stakeholder Conference on Improving Patient Access to Injectable Medications explored how the pharmacy profession could advance a broad-based, profession-wide practice model for MAS across a wide spectrum of therapeutic classes. There is a significant public health need to expand access to patients and make MAS a widely available, predictable, measurable, and scalable service provided by pharmacists. Conference participants discussed scope of practice, service delivery, and business model barriers. They also identified tools and resources that are necessary to overcome those barriers to advance opportunities and develop long-term, sustainable strategies to increase access to MAS from community-based pharmacist practitioners. Conclusion Conference outcomes provided specific guidance around the need to develop practice support to address public health needs and effectively advance pharmacist provision of MAS and related patient care services. Key recommendations included the development of national practice guidance, standardized education and training, practice-level tools and resources, and enhanced technology solutions.

Objectives The American Pharmacists Association (APhA) convened the Biologics and Biosimilars Stakeholder Conference on November 30, 2016, in Washington DC. The objectives of the Conference were to determine the key issues and challenges within the marketplace for biologics, follow-on biologics (FOBs), and biosimilars, identify potential roles and responsibilities of pharmacists regarding biologic and biosimilar medications, and identify actions or activities that pharmacists may take to optimize the safe and cost-effective use of biologics and biosimilars. Data sources National thought leaders and stakeholder representatives, including individuals from the Food and Drug Administration, Centers for Medicare and Medicaid Services, a private third-party payer, manufacturers, and several national organizations of health care professionals, participated in the conference. Information shared by this group was supplemented with relevant legal and regulatory information and published literature. Summary Biologics play a valuable role in the treatment of numerous health conditions, but their associated costs, which tend to be greater than those of small-molecule drugs, place a burden on the health care system. Biosimilars (both noninterchangeable and interchangeable) are highly similar copies of the originator biologic and offer the potential to reduce costs and improve patient access to biological products by increasing treatment options and creating a more competitive market. Despite the potential benefits of biosimilars, certain factors may limit their uptake. The conference participants explored issues that different stakeholders think influence the use of biologics, including biosimilars, in the United States. Barriers included technology, prescriber–pharmacist communication, legislation and regulations, limited patient and health care practitioner knowledge of biological products, patient and health care practitioner perceptions of biosimilars, and evolving science or lack of long-term data. After participants identified issues, they discussed strategies to address these concerns, including the need to enhance the education of pharmacists, prescribers, and patients regarding biologic products, including biosimilars and FOBs; the passage of state laws and regulations that do not impede the use of biosimilars, including interchangeable biosimilars; the use of product-specific tracking information in electronic health records and surveillance systems; bidirectional communication among pharmacists, prescribers, and other members of the care team to support pharmacovigilance and the maintenance of accurate patient records; and the development of evidence-based third-party payer policies. Conclusion Patient access to safe and cost-effective treatments is an important goal for the health care system. As the availability and use of biosimilars, including those determined to be interchangeable, increases, their potential to lower costs and improve patient access to treatment grows. However, the extent of such growth is, in part, dependent on various stakeholders' decisions to provide, pay for, or use these products in a safe and thoughtful manner. Ongoing stakeholder collaboration, educational activities, and review of current government or payer policies are required to optimize the uptake of biological products, including biosimilars.

Objectives The Community Pharmacy Residency Program (CPRP) Planning Committee convened to develop a vision and a strategic action plan for the advancement of community pharmacy residency training. Aligned with the profession's efforts to achieve provider status and expand access to care, the Future Vision and Action Plan for Community-based Residency Training will provide guidance, direction, and a strategic action plan for community-based residency training to ensure that the future needs of community-based pharmacist practitioners are met. Data Sources National thought leaders, selected because of their leadership in pharmacy practice, academia, and residency training, served on the planning committee. The committee conducted a series of conference calls and an in-person strategic planning meeting held on January 13-14, 2015. Outcomes from the discussions were supplemented with related information from the literature. Results of a survey of CPRP directors and preceptors also informed the planning process. Summary The vision and strategic action plan for community-based residency training is intended to advance training to meet the emerging needs of patients in communities that are served by the pharmacy profession. The group anticipated the advanced skills required of pharmacists serving as community-based pharmacist practitioners and the likely education, training and competencies required by future residency graduates in order to deliver these services. The vision reflects a transformation of community residency training, from CPRPs to community-based residency training, and embodies the concept that residency training should be primarily focused on training the individual pharmacist practitioner based on the needs of patients served within the community, and not on the physical location where pharmacy services are provided. Conclusion The development of a vision statement, core values statements, and strategic action plan will provide support, guidance, and direction to the profession of pharmacy to continue the advancement and expansion of community-based residency training.

Objective The purpose of this initiative was to establish a Coordinating Council to Improve Collaboration in Supporting Patients with Alzheimer's Disease. The Council convened on March 5–6, 2008, in Washington, DC. The American Pharmacists Association (APhA) Foundation, in conjunction with leading national experts in Alzheimer's disease (AD), assessed the level of care and services currently provided by pharmacists to AD patients and developed this “blueprint document” for how they might be more effective in helping patients and family caregivers manage the burden of this devastating disease. Data source A premeeting survey of Council members was conducted to elicit their perceptions regarding the needs and challenges facing AD patients and their family caregivers and to gain insights as to what roles pharmacists could and should be playing to help manage drug therapy and enhance the quality of life in patients with AD. Summary AD is one of the most significant health crises that will be faced in the United States over the next 30 years. Currently, it is the sixth leading cause of death in the country. The findings of the Council confirmed that pharmacists are playing important roles in the management of AD but can expand these roles. Conclusion Pharmacists are accessible, trusted, and respected resources. Increased pharmacist involvement in the care of individuals with AD could improve clinical outcomes and family caregiver quality of life. With the expected increase in the number of individuals diagnosed with AD, the resources and services to care for and support this population will be even further taxed. Innovative approaches for expanding pharmacist involvement in AD should be developed to maximize the difference pharmacists can make in the lives of those who suffer from the disease.

Objective: To improve key indicators of diabetes care by expanding a proven community-based model of care throughout high-risk areas in the United States. Design: Observational, multisite, pre–post comparison study. Setting: Federally qualified health centers, free clinics, employer worksites, community pharmacies, departments of health, physician offices, and other care facilities in 25 communities in 17 states, from June 2011 through January 2013. Participants: 1,836 patients disproportionately affected by diabetes representing diverse ethnicities, insurance statuses, and social and economic backgrounds. Intervention: Pharmacists were integrated into local, interdisciplinary diabetes care teams and provided customized diabetes education and medication consultations to patients. Main outcome measures: Clinical measures included glycosylated hemoglobin (A1C), body mass index, systolic and diastolic blood pressures, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and total cholesterol. Process measures included smoking status, eye examination status, foot examination status, and influenza vaccine status. Results: Pharmacist patient care services for those underserved or disproportionately affected by diabetes resulted in a statistically significant and clinically relevant decrease in mean A1C levels (–0.8%). Other outcome indicators were below target levels at baseline and decreased significantly but not by clinically relevant amounts (LDL-C, −7.1 mg/dL; triglycerides, −23.7 mg/dL, and total cholesterol, −8.8 mg/dL). The mean increase in HDL-C (+0.6 mg/dL) was not statistically significant or clinically relevant. Among evaluable patients who were not at target for process measures at baseline, 51.7% of 453 patients received eye examinations, 72.0% of 271 patients received foot examinations, 41.7% of 307 patients received influenza vaccinations, and 9.3% patients of 270 quit smoking during the project. Of the communities involved in the study, 92% intend to sustain pharmacists’ services. Conclusion: Project IMPACT: Diabetes results show significant improvement in patients’ clinical outcomes and demonstrate that all patients, even those with tremendous barriers to appropriate diabetes care, benefit from patient-centered, interdisciplinary health care teams that include pharmacists.

Objectives To describe the development and implementation of the Discussions on Taking Medications (DOT x .MED) Diabetes Pilot Program and to report the impact on adherence to diabetes therapy, improvement in communication of pharmacists, and satisfaction of patients, pharmacists, and health care providers. Participants 10 community pharmacy residency sites across the United States enrolled 216 patients with diabetes to participate in the pilot project. Intervention Pharmacists delivered behavioral interventions using motivational interviewing techniques and increased personal communication with patients during routine visits to the pharmacy during a 6-month period. Results During the initial 6-month pilot program, modest improvements in medication adherence were documented. Patients in the intervention group showed a 6.55% increase in proportion of days covered (PDC) compared with the previous 180 days preintervention and a 2.8% increase in PDC compared with the control group. Based on survey results, overall reports of satisfaction from patients, pharmacists, and health care providers were favorable. Conclusion Access to educational programs, tools, and resources provided through the DOT x .MED Diabetes Pilot Program improved pharmacist knowledge of diabetes care and increased the amount of time spent communicating with patients. The program demonstrated that small, focused interactions addressing issues of concern to patients can improve patient adherence to medication therapy.

Primary care is the foundation of the U.S. healthcare system. The Institute of Medicine (IOM) defines primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community”.1 When optimally delivered, primary care fosters wellness and prevention of chronic diseases and problems. Primary care often serves as the point of entry for patients who require medical care and attention. In addition to the diagnosis and treatment of acute and chronic illness, primary care practice encompasses activities such as health promotion, disease prevention, health maintenance, counseling, and patient education. Medications play a critical role in primary care and their effective management is essential to patient safety and quality care. Primary care activities occur across a variety of health care settings.2 Patient involvement and empowerment are key components of primary care practice – which require effective two-way communication and the recognition of the patient as a partner in their own health care. IOM defines patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, values, and ensures that patient values guide all clinical decisions”. The American Academy of Family Physicians asserts that primary care practices should be located in “the community of patients”, thereby facilitating access to health care. Unmet Chronic and Preventive Public Health Needs Nearly half of all Americans—and over three-fourths of adults aged 65 and older—live with at least one chronic condition that requires medication therapy.3 Chronic diseases are appearing with increasing frequency in younger adults and even children, likely a direct result of societal trends including unhealthy diets, oversized serving portions, and inactivity, which collectively contribute to early development of type 2 diabetes, dyslipidemias, and obesity. Likewise, preventable complications from each of these conditions are also on the rise. As a result, 75 percent of our nation's $2 trillion in annual health expenditures are attributable to management of problems associated with chronic diseases.4 While chronic diseases are common and costly, many are also preventable—through strategies such as healthy eating, being physically active, avoiding tobacco use, and using medications safely and appropriately. The current Presidential Administration is committed to reforming the U.S. healthcare system and has proposed the largest federal investment in promoting and providing preventive care. It is clear that preventive care is one of the best ways to keep people healthy and reduce the costs of healthcare. Wellness and prevention are hallmarks of primary care and offer expanded opportunities for improving access to care for millions of U.S. citizens, many of whom have been disproportionately affected by the lack of care including the elderly, low income, minority populations, and those located in areas with little or no access to primary care providers.