Precision of Medication Therapy Problem Identification and Classification amongst Primary Care Clinic Pharmacists

This study assesses the level of agreement on medication therapy problem (MTP) identification and classification between primary care, ambulatory care pharmacists within a health-system that recently implemented system-wide pharmacist provision of comprehensive medication management (CMM) services. Twenty standardized case vignettes were created and distributed to pharmacists who reviewed each case and identified and categorized MTPs. Outcomes include the number of MTPs identified, identification (yes/no) of specific MTPs within each case (e.g., need for a statin), and Pharmacy Quality Alliance (PQA) category used when classifying MTPs. The level of agreement on MTP identification/categorization was measured using intraclass correlation coefficient (ICC) and interpreted using the Landis and Koch interpretation scale. “Moderate agreement” was observed for the number of MTPs identified by pharmacists (ICC equal to 0.45; 95% confidence interval [CI]: 0.31 to 0.65). In approximately one-half of opportunities, the pharmacists agreed perfectly on the number of MTPs; in approximately one-third of opportunities, the number of MTPs identified varied by 1; and approximately one-tenth of the time, the number of MTPs varied by 2. In regard to the MTP identification (yes/no) and categorization, percent agreement was ≥73% across all MTPs. The results support the need for further training and education and provide the information necessary to target specific disease states.

A Journey through the History of Drug Quality Control, from Greece to Costa Rica

This review describes the evolution and development of drug quality control throughout different times in history. A bibliographic research was conducted from the database JSTOR from the University of Costa Rica. This database contains information from academic journals and books from XIX to date. It covers different fields, such as anthropology, arts, biology, botany, health sciences, politics, pharmacy, history. Information was retrieved when the following words were present: pharmacy, quality, quality control, drugs, medicines, pharmacopoeia. In ancient history India, China, Greece, Egypt, Africa and America used different medicinal plants to cure or alleviate disease. In some of these regions, methods were developed to make medicinal preparations as safe and effective as possible. In ancient Greece, the need to have a complete knowledge of drugs to carry out their proper preparation and detect adulterations was emerging. In Europe there was a constant development in the field, from books containing simple lists of preparations and medicines to more complex pharmacopoeias that included quality of the medicines. In America, the United States Pharmacopoeia (USP) first appeared in 1820. In Costa Rica, the Specialized Laboratory for Drug Analysis, actually the Laboratory for Analysis and Pharmaceutical Consulting (LAYAFA), was created in 1965, to ensure the quality and safety of medicines registered and marketed in Costa Rica. Differences between regulations and quality standards across centuries and countries, and their impact on the commercialization of medicines, have promoted regulations to harmonize the requirements related to different activities of the processes of manufacture, registration and quality control of medicines.

Identifying Medication Therapy Problems Related to Cognition Among Older Adults Followed by a Home-Based Care Team

Complications from dementia, depression, delirium (3Ds) and polypharmacy may accelerate patient decline. Cognitive vulnerabilities may be under-recognized and medication therapy problems (MTPs) overlooked, hindering optimal care. Clinical pharmacists on a multidisciplinary home-based care team (HBCT) being tested in a clinical trial were essential in identifying MTPs related to cognition. Medicare Advantage members >65 years old, living at home in Connecticut, with ICD-10 codes related to 3Ds were eligible. APRNs conducted in-home medication reconciliation along with medical and cognitive assessments. HBCT pharmacists assessed medication lists for MTPs related to indication, effectiveness, and safety (adverse events, interactions). After review by the HBCT APRN, geriatrician, and psychiatrist, salient pharmacist recommendations were forwarded to PCPs for consideration. Using retrospective analysis, MTPs and recommendations were classified based upon the Pharmacy Quality Alliance framework. MTP analysis included 105 patients enrolled from 2017-2019. We found 166 MTPs related to cognition, with a mean (SD) of 1.58 (1.35) (range 0-6) MTPs per patient. MTPs related to indication accounted for 34% (57/166) of total MTPs, of which 79% (45/57) were underuse and 21% (12/57) overuse; effectiveness represented 13% (22/166) of MTPs; safety represented over half (52%; 87/166) of total MTPs with benzodiazepines and anticholinergics commonly implicated. Common HBCT pharmacists’ recommendations included discontinuation (23%; 38/166) and dose reduction (19%; 32/166). MTPs related to cognition were found among the overwhelming majority (79%) of patients. This work is significant because it supports the value of pharmacists on multidisciplinary teams to address cognitively harmful medications, dementia treatment side effects, and untreated cognitive conditions.

Coping with the residency program during COVID-19: Hematology oncology pharmacy residents’ perspective

Introduction The COVID-19 pandemic has led to significant changes in all governmental activities in Saudi Arabia including training and teaching, with the majority of such activities suspended in response to the COVID-19 pandemic. We aim to share the challenges that Hematology Oncology Pharmacy (HOP) residents faced during the quarantine period and provide recommendations on how to cope with the residency journey. Method We followed a qualitative methodological approach in March 2020 using a structured virtual group discussion for data generation. Results All six PGY2 hematology oncology pharmacy (HOP) residents were included in the group discussion. The group agreed that the need for HOP services during this pandemic is beyond the scope of oncology pharmacists’ normal daily practice. The group recognized two fundamental points. First, the goal of the current training should be customized to the most pressing need and recognized at the national level. Second, the current training system should be improved to ensure efficient use of current resources. On this basis, the group developed six main recommendations for action. Conclusion The current situation is a challenge for all healthcare providers, and the majority of the nation’s current generation never dealt with such a situation in days gone by. This paper presents the challenges that should be addressed at the national level and provide a fundamental consensus recommendation for practical approaches to maximize learning and minimize disruption to trainees’ progression while maintaining patient-pharmacy quality of care.

Study on Quality Indicators of Pharmacy in a tertiary Care teaching hospital, Kozhikode

Quality Indicators in pharmacy is essential to address the Prescription errors and other quality-related problems in the pharmacy. Quality indicators can be used, adopted in every aspect and even to the staff. An average of 5000 Prescriptions was analysed for four months in a tertiary care teaching hospital at Kozhikode. Total of 64 staff was chosen for the study which comprised of pharmacists, patients and other staff members. The analysis carried out on the dispensing errors and also the wastage of drugs happening in the pharmacy. There were significant dispensing errors and wastage of drugs happening in the pharmacy which can not only affect the patients but also could bring the financial loss for the pharmacies due to wastage of drugs. The study recommends for the enhancement in the quality of pharmacies as these quality indicators are required for the better public health care and also to avoid the wastage of the drugs causing financial loss to the Pharmacies

Use of Pharmacy Quality Measures to Enhance Value-Based Performance Within the Military Health System

Introduction As the healthcare system shifts from fee-for service toward value-driven healthcare, interest has grown in medication-related quality metrics to evaluate quality and value within the healthcare system. While the Defense Health Agency (DHA) has taken steps to align healthcare quality measures across the enterprise, the extent to which DHA utilizes pharmacy quality measures (PQMs) or evaluates the quality of direct and purchased pharmacy care is unknown. Materials and Methods A comparison was made between existing PQMs utilized by DHA and all measures published and endorsed by the Pharmacy Quality Alliance (PQA), a recognized, PQM standard-setting organization. We also compared DHA PQMs to those used within the Medicare Part D Star Rating Program. Results DHA has implemented 10 (28%) of the 36 PQA measures available for evaluation as of August 2019. Of the five measures included in the 2020 CMS Part D Star Rating program, DHA has currently implemented four (80%) of the measures. DHA has implemented 3 of the 5 (60%) PQA CMS Display Measures, and 5 of 9 (56%) PQA CMS Patient Safety Report Measures that are not part of the Star Ratings, but that are used to benchmark and provide feedback to health plans. Conclusion Opportunities exist within the DHA to leverage PQMs to evaluate the quality of pharmaceutical care, build trust with beneficiaries by increasing transparency, and maintain parity with the civilian healthcare system. Existing models and commercially available technology could be considered to rapidly operationalize the use of PQMs within the MHS.