Pharmacist medical provider status in Alaska,the last frontier

Alaska law and health care policies, incidentally, designate pharmacists as billable medical providers when providing health care services. However, state and commercial provider enrollment and claims processing systems are not configured to enroll and accept claims from pharmacists. Alaska law does not protect pharmacists from unfair discriminatory practices by payors despite such protections being afforded in federal regulation. Additional advocacy and legislation are needed to fully implement pharmacists as billing medical providers within traditional payor models. Health care services provided by pharmacists can help alleviate unmet patient health care needs in the community and primary care settings of Alaska. The identified barriers will continue to limit the ability of pharmacists in Alaska to sustainably provide lifesaving, scope-permitted, and otherwise covered services to those in greatest need.     

医疗机构执业药师的作用

随着药品终端服务业的快速发展,执业药师的数量增长迅速,1994～1999年全国执业药师数量仅有1.5万人,而2000～2005年执业药师的数量已达11.45万人, 5～6年的时间数量翻了近7倍,而其中60%～70%的执业药师在医疗机构工作.     

Community-level policy responses to state marijuana legalization in Washington State

BackgroundWashington State (WA) legalized a recreational marijuana market – including growing, processing and retail sales – through voter initiative 502 in November 2012. Legalized recreational marijuana retail sales began in July 2014.In response to state legalization of recreational marijuana, some cities and counties within the state have passed local ordinances that either further regulated marijuana markets, or banned them completely.The purpose of this study is to describe local-level marijuana regulations on recreational retail sales within the context of a state that had legalized a recreational marijuana market.MethodsMarijuana-related ordinances were collected from all 142 cities in the state with more than 3000 residents and from all 39 counties. Policies that were in place as of June 30, 2016 – two years after the state’s recreational market opening – to regulate recreational marijuana retail sales within communities were systematically coded.ResultsA total of 125 cities and 30 counties had passed local ordinances to address recreational marijuana retail sales. Multiple communities implemented retail market bans, including some temporary bans (moratoria) while studying whether to pursue other policy options. As of June 30, 2016, 30% of the state population lived in places that had temporarily or permanently banned retail sales. Communities most frequently enacted zoning policies explicitly regulating where marijuana businesses could be established. Other policies included in ordinances placed limits on business hours and distance requirements (buffers) between marijuana businesses and youth-related land use types or other sensitive areas.ConclusionsState legalization does not necessarily result in uniform community environments that regulate recreational marijuana markets. Local ordinances vary among communities within Washington following statewide legalization. Further study is needed to describe how such local policies affect variation in public health and social outcomes.     

Rising prevalence of gastroschisis in Washington State

The aim of this study was to assess gastroschisis prevalence in Washington (WA) State in relation to putative risk factors. Gastroschisis prevalence was calculated from the WA State birth cohort during 1987-2006 using an administrative database with birth certificate data linked with hospital discharge records and the ICD-9 procedure code 54.71, which specifies gastroschisis repair. Poisson regression analysis was used to evaluate time trends while adjusting for risk factors. Birth year was included as a linear term. Maternal age, smoking, race, residence in urban versus rural area, geographic region (eastern versus western Washington), paternal age, and infant gender were included as categorical factors. Prevalence ratios were adjusted for birth year and all of the preceding factors. Two hundred and eighty-two infants with gastroschisis were identified. In the adjusted analysis, the prevalence ratio for gastroschisis was 1.1 per year (95% CI 1.08-1.13), indicating an average 10% increase per birth year. Teen mothers were at a higher risk compared to mothers≥25 yr old (adjusted rate ratio [aRR] 8.02; 95% CI 5.30-12.13), as were teen fathers (aRR 2.35; 95% CI 1.48-3.74) compared to fathers≥25 years old. Maternal smoking was associated with a higher risk compared to those who were nonsmokers (aRR 1.58; 95% CI 1.19-2.09). Black mothers had a lower risk compared with white mothers. There was no association with geographic classification of mother's residence. Gastroschisis prevalence has increased in WA, particularly in teen mothers and in smokers. This is not explained by a rise in teenage pregnancies or maternal smoking. Further investigation of factors specific to teenage lifestyle is warranted.     

我国总药师制度发展现状及启示

目的促进我国试点地区总药师制度持续完善。方法梳理总结国内目前已实施总药师制度的试点地区政策经验,发现实施过程中的问题,并提出针对我国目前总药师制度的发展建议。结果目前全国已有9个省份的百余家医疗机构试点设立了总药师岗位,尤以2017年之后增加明显。结论试点地区实施总药师制度以来,虽然对推动药学服务高质量发展有一定的促进作用,但总药师制度作为一项创新性、探索性工作,仍存在部分医疗机构对总药师制度的认知不足、部分总药师管理能力及专业技能不强及部分偏远地区推广实施总药师制度较难等问题。     

Topiramate-positive death-investigation and impaired-driving cases in Washington State

Topiramate (Topamax), an effective seizure disorder treatment, received additional FDA approval for prevention of migraine headaches in August 2004 and has gained attention for its off-label uses, including psychiatric and eating disorders, neuropathic pain, and alcohol and drug dependency. Side effects of sedation, dizziness, ataxia, speech difficulty, nystagmus, paresthesia, and metabolic acidosis are described. The manufacturer reports that tolerance to the antiseizure properties does not develop. With its established efficacy for epilepsy treatment and its increased use for other disorders, topiramate-positive findings are more common in death-investigation and human-performance casework. To evaluate the role of topiramate, we reviewed all topiramate-positive cases from our laboratory between 1998 and 2004, which constituted 132 cases (63 death investigations, 68 suspected impaired drivers, and 1 sexual assault case). The subjects were predominantly female (69%) with a mean and median age of 42. Blood topiramate concentrations ranged from 1 to 180 mg/L (median 6.4 mg/L, mean 8.4 mg/L), and 94% were positive for at least one additional drug. There was evidence of psychomotor impairment in some drivers with blood concentrations within the normal therapeutic range, and deaths attributed to topiramate alone occurred at concentrations as low as 50 mg/L.     

Improved pharmacy services through pharmacist participation in medical rounds.

The participation by pharmacists in medical rounds in a 250-bed pediatric hospital with centralized unit dose drug distribution and i.v. admixture programs is discussed. A redistribution of responsibilities enabled pharmacists to attend physician work rounds on each medical service. Nursing-pharmacy rounds were set up for services which had no scheduled physician work rounds. As a result, the amount of medication waste due to late order changes, which had previously been a problem, was reduced by 0.54 cents per patient day. Pharmacist participation in medical rounds increased his clinical expertise and supplied him with the clinical data necessary to make more informed recommendations to physicians.     

Identifying discrepancies in electronic medical records through pharmacist medication reconciliation

ObjectivesTo describe the types and causes of medication discrepancies in the electronic medical record identified by pharmacist medication reconciliation during outpatient medical visits and to identify patient characteristics associated with the presence of discrepancies.DesignObservational case series study.SettingIndigent primary care clinic in Pittsburgh, PA, from April 2009 to May 2010.Patients219 adults presenting for follow-up medical visits and self-reporting medication use.InterventionMedication reconciliation as part of patient interview and concurrent chart review.Main outcome measuresFrequency, types, and reasons for medication discrepancies and demographic variables, patient knowledge, and adherence.ResultsOf 219 patients interviewed, 162 (74%) had at least one discrepancy. The most common type of discrepancy was an incorrect medication documented on the chart. The most common reasons included over-the-counter (OTC) use of medications and patients not reporting use of medications. The presence of one or more medication discrepancies was associated with the use of three or more medications. Patient factors such as gender, age, and race were not associated with discrepancies. Patients able to recall the strength for more than 75% of their medications had fewer discrepancies, while knowledge of the medication name, indication, or regimen had no association with discrepancies.ConclusionPharmacists play a critical role in identifying discrepancies between charted medication lists and self-reported medication use, independent of adherence. Inaccuracies in charted medications are frequent and often are related to use of OTC therapies and lack of communication and documentation during physician office visits. Knowledge of patient-related variables and other reasons for discrepancies may be useful in identifying patients at greatest risk for discrepancies and interventions to prevent and resolve them.     

Evaluating provider acceptance of pharmacist interventions in the Discharge Companion Program and its association with readmission reduction

ObjectiveTo evaluate provider acceptance of pharmacist interventions within the Discharge Companion Program (DCP) and its association with hospital readmissions.MethodsThis retrospective record review included patients referred to the DCP between January and October 2018. DCP pharmacists’ interventions were assessed for provider acceptance on follow-up consultation or readmission. A chi-square test assessed the association between provider acceptance, communication modality, and technology used. A logistic regression model assessed the association between readmission risk and variables of interest. An a priori alpha level of 0.05 was used.ResultsOf the 197 patients referred to the DCP, 102 met inclusion criteria. DCP pharmacists made a total of 271 interventions; 185 (68.7%) required provider action. The most common intervention type was medication addition or discontinuation (n = 74, 40%); the communication mode was between DCP nurses and primary care provider offices or skilled nursing facilities (n = 56, 54.9%); and the preferred technology was the telephone (n = 58, 56.9%). Provider acceptance rate was 30.8% (n = 57) of actionable interventions, although it was not significantly associated with 30-day readmission reductions (P = 0.833) and did not differ significantly when interventions were communicated to other health care professionals (P = 0.53). The specific intervention communication mode (i.e., telephone, facsimile, or both) of pharmacist interventions did not significantly affect provider acceptance (P = 0.133). The overall readmission rate was 22.5% (n = 23), and the only significant predictor of 30-day readmission was the number of comorbidities (odds ratio 1.28 [95% CI 1.03–1.58], P = 0.024).ConclusionProvider acceptance of pharmacists’ interventions did not significantly affect 30-day readmission rates, regardless of communication mode (telephone or facsimile) or technology used. However, the DCP successfully identified numerous medication-related problems. Further study is warranted regarding provider acceptance of pharmacist recommendations on 30-day readmission reduction.     

医院药师在尼泊尔强烈地震医疗救援中的作用

目的:简述医院药师在援外医疗救援中的作用,为进一步做好医疗救援中药学服务相关工作提供参考。方法:笔者通过参与首支中国政府医疗队驰援尼泊尔8.1级强烈地震医疗救援工作的亲身经历,阐述医院药师在援外抗震救灾医疗救援过程中在救援药品准备、提供药学信息、做好医师用药参谋、为患者提供合理用药咨询与指导、保障药品质量等方面发挥的积极作用;并针对救援过程中发现的问题提出了自己的看法与建议。结果与结论:医院药师在援外医疗救援的药学服务中发挥了不可或缺的作用,为中国政府医疗队顺利完成医疗救援任务做出了积极贡献,为今后类似救援工作积累了一定经验,奠定了实践基础;作为国家紧急医学救援成员单位,其相关应急预案尚有待进一步完善,为不断提升救援工作质量与效率奠定坚实的基础。     

The emergency contraception collaborative prescribing experience in Washington State

OBJECTIVE: To describe how prescribers and pharmacists view the Emergency Contraceptive Pills (ECP) program, and to evaluate pharmacists' performance through the use of a consumer survey. DESIGN: Self-administered provider satisfaction surveys were mailed 6 months after the program's inception. Consumer satisfaction surveys were distributed at the point of ECP service for return by mail. SETTING: The program encouraged pharmacists and prescribers in western Washington to enter into collaborative prescribing agreements, increasing consumers' access to ECP. PATIENTS OR OTHER PARTICIPANTS: Pharmacists who had attended ECP training sessions, prescribers who had authorized pharmacists to prescribe ECP, and women who had been prescribed ECP by pharmacists. MAIN OUTCOME MEASURES: Providers' reasons for participating, attitudes toward the ECP program, and experiences with ECP as a result of the program; feedback from women receiving ECP from pharmacists. RESULTS: 309 pharmacist surveys and 55 prescriber surveys were sent, of which 159 (51%) and 27 (49%), respectively, were returned. Meeting patient needs and having a professional responsibility to participate were commonly reported reasons for ECP program involvement. Both pharmacists and prescribers (92%) reported being "satisfied" or "very satisfied" with their prescribing agreements. On the 470 consumer surveys returned out of 7,000 distributed (6.5%), pharmacists were rated highly satisfactory for their interactions with patients and the quality of information about ECP use given, but less satisfactory for information about adverse effects, recognition and follow-up of ECP failure, and regular contraceptive methods. CONCLUSION: All participants expressed satisfaction with the ECP program. This example should support the initiation of similar programs in other states.     

The utility of a medical admissions pharmacist in a hospital in Australia

Background Medication-related hospital admissions in Australia have previously been estimated to account for approximately 3% of all hospital admissions, with hospital entry points being a point of vulnerability. The timely medication review and reconciliation by a pharmacist at the early stage of an admission for patients admitted to the Acute Medical Unit (AMU) would be beneficial. Setting The Emergency Department (ED) and AMU in a 300 bed tertiary teaching hospital, in South Australia. Objective To investigate the impact of a Medical Admissions (MA) pharmacist on the proportion of AMU patients who receive a complete and accurate medication history by a pharmacist prior to admission and within 4 h of presentation. Method This prospective observational study with a non-concurrent parallel study design examined a standard clinical pharmacist service within the AMU and ED to a Medical Admissions (MA) Pharmacist, in addition to the standard AMU and ED pharmacist service. Continuous variables were analysed using a two sample t test, whilst categorical data were analysed using Fisher’s exact test. Risk ratios were also calculated for categorical data, with p < 0.05 taken as statistically significant. Main outcome measures Rates of completion of a complete medication history prior to admission and proportion of patients seen within 4 h of presentation by a pharmacist. Results The intervention resulted in more patients receiving a complete medication history prior to admission (2.7% in the control group vs 18.5%, p < 0.01) and being seen by the pharmacist within 4 h of presentation (1.6% in the control group vs 7.5%, p < 0.01). Conclusion Implementation of an extended hours clinical pharmacy service in the form of a medical admissions pharmacist based in the ED significantly increased the number of complete medication histories and clinical reviews completed for patients being admitted to an AMU. These were also completed earlier in the patients’ admission. There was also a small trend toward increasing the proportion of patients discharged by 11 am in the intervention group.