Jerry Fahrni

Tag: Pharmacy Practice

  • Med Adherence – Difference between prescribed and dosing histories [Article]

    Annual Review of Pharmacology and Toxicology (2012 Feb 10;52:275-301. Epub 2011 Sep 19) – No big surprise here, but check out the graphs (posted below), especially the second one where you can see the effect poor compliance/adherence has on therapeutic concentration. Crazy.

    Abstract

    Satisfactory adherence to aptly prescribed medications is essential for good outcomes of patient care and reliable evaluation of competing modes of drug treatment. The measure of satisfactory adherence is a dosing history that includes timely initiation of dosing plus punctual and persistent execution of the dosing regimen throughout the specified duration of treatment. Standardized terminology for initiation, execution, and persistence of drug dosing is essential for clarity of communication and scientific progress. Electronic methods for compiling drug dosing histories are now the recognized standard for quantifying adherence, the parameters of which support model-based, continuous projections of drug actions and concentrations in plasma that are confirmable by intermittent, direct measurements at single time points. The frequency of inadequate adherence is usually underestimated by pre-electronic methods and thus is clinically unrecognized as a frequent cause of failed treatment or underestimated effectiveness. Intermittent lapses in dosing are potential sources of toxicity through hazardous rebound effects or recurrent first-dose effects.

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  • Surprise! Pharma says their “digital resources” are good for consumers

    Sirensong

    Reliance on pharma-sponsored digital resources among online U.S. adults is significant. The research found “51% of online U.S. adults (ages 18+) use pharma-sponsored digital resources, such as condition and treatment information, disease management tools, doctor discussion guides, or mobile apps or websites.” This validates that the interactive information and tools produced by biopharma are being utilized and appreciated.

    Use of these materials results in action: a conversation about a prescription drug. The study learned “43% of consumers using pharma-sponsored digital resources have discussed prescription drugs with a doctor, nurse, or pharmacist as a result.” This data point supports the business objective behind providing these interactive resources: generating a conversation with a healthcare professional. Note that the study was fielded online among 6,634 U.S. adults, ages 18+ during Q4 2011.

    For comparison, Prevention Magazine’s Direct to Consumer Study 2011 found that as a result of seeing an advertisement – not necessarily online – 77% of survey respondents talked to a doctor and 23% asked for a prescription.

    How scary is this! Getting consumers to talk about their medication with their physician is a good thing; talking with their pharmacist even better. However, many times this type of advertising (“digital resource”) results in consumers asking about something completely inappropriate. Which, as we all know, can lead to  a physician prescribing an unnecessary medication, using something that they’re not familiar with or prescribing something they wouldn’t consider first line.

    All you have to do is look at the top 5 “patient and caregiver groups to agree that pharma should be involved in online health consumer communities” to understand why this is such a bad idea.

    1. ADD/ADHD Caregivers
    2. Bipolar Disorder Caregivers
    3. Epilepsy Caregivers
    4. Cystic Fibrosis Patients
    5. Rheumatoid Arthritis Patients

    Yikes! Choosing drug therapy is quite a bit different than picking out a book on Amazon and it should be treated that way.

  • Impact of Anti-infective Drug Shortages [Article]

    Clinical Infectious Disease (online January 19):

    Abstract

    Anti-infective shortages pose significant logistical and clinical challenges to hospitals and may be considered a public health emergency. Anti-infectives often represent irreplaceable life-saving treatments. Furthermore, few new agents are available to treat increasingly prevalent multidrug-resistant pathogens. Frequent anti-infective shortages have substantially altered patient care and may lead to inferior patient outcomes. Because many of the shortages stem from problems with manufacturing and distribution, federal legislation has been introduced but not yet enacted to provide oversight for the adequate supply of critical medications. At the local level, hospitals should develop strategies to anticipate the impact and extent of shortages, to identify therapeutic alternatives, and to mitigate potential adverse outcomes. Here we describe the scope of recent anti-infective shortages in the United States and explore the reasons for inadequate drug supply.

    Unfortunately the abstract doesn’t say much and a subscription is required to read the full article [grrr!]. The authors of the article basically evaluate the shortage of anti-infective agents over a multi-year period (2005-2010) and conclude that “anti-infective drug shortages continue to pose significant problems for clinicians and are a rapidly evolving public health emergency.” In addition they call for further research “regarding the clinical impact of drug shortages on patient outcomes”. How would one perform such a study?

    Drug shortages have received a lot of attention lately. Shortages are certainly nothing new, but they seem to have become a bigger issue lately as the sheer number of unavailable medications is staggering. Areas like oncology and infectious disease are particularly hard hit as the number of treatment options in these specialties are limited to start with.

    While there is no doubt that the shortages have impacted healthcare, I tend to agree with the authors of a commentary piece on the article that conclude that " it is difficult to systematically measure the resulting clinical problem or draw quantitative conclusions about differences in outcomes." Sounds overly simplified, but it’s true.

    For more information on drug shortages make sure to visit the ASHP Drug Shortages Resource Center. Over 200 drugs and counting…

  • Domain expertise in healthcare can go a long way

    mobilehealthnews: “[John] Sculley said [while speaking at the Digital Health Summit, CES 2012] that some companies have put too much emphasis on style over substance.

    “The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,””

    I think these comments ring true for many of us that realize the disconnect between the people designing and building products for healthcare, and those actually using them. I can attest to the fact that it exists in many aspects of pharmacy automation and technology where things have a way of being forced down your throat. It becomes a game of which product is the “least bad”. It’s called settling for something, and it never really makes anyone happy. That’s why we’ve seen so many homegrown systems in pharmacies over the years.

    There once was time when terrible usability at least meant great functionality. Unfortunately many companies have chosen to improve the usability at the expense of the functionality, which ultimately leads to a crappy product. I’ve experienced this many times during my career, especially with pharmacy information systems where improved UI’s have often resulted in poor performance, more mouse clicks and frustration.

    Do the industry a favor and ask the end users what they need, instead of giving them what you think they want.

  • Expanding the role of pharmacy technicians

    If you know me then you know that I’m a proponent of expanding the role of pharmacy technicians in the acute care pharmacy setting. I believe pharmacy technicians are underutilized and are capable of doing many functions within a healthcare system to improve patient care, both directly and indirectly, as well as free up pharmacists to do the things they should be doing.

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  • Telemedicine in rural areas [video]

    Seems like a reasonable platform for clinical pharmacy services.

  • Eliminating Barriers To Care Using Technology [Video]

    Interesting video that talks about the use of telepharmacy for Medication Therapy Management (MTM).

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  • Telepharmacy, it’s not just a made-up word

    radionewsThe definition of telemedicine is “the use of telecommunication technologies to deliver medical information and services to locations at a distance from the care giver or educator.” So what’s the definition of telepharmacy? I’m not quite sure, but replacing “medical information and services” with “pharmacy information and services” seems reasonable.

    I saw a lot of interest in telepharmacy at the ASHP Midyear meeting in New Orleans last month. Based on all the activity one might think it’s a new concept. Au contraire, telemedicine has been around since at least the 1960’s, when NASA built this technology into spacecraft and astronauts’ suits to monitor physiological parameters. Crud, one could argue that the concept has been around much longer than that (see image to the right from April 1924).

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  • GPhA reveals the ARI to address drug shortages

    Did you know there was a Generic Pharmaceutical Association (GPhA)? Well, if you did you’re a step ahead of me because I’d never heard of them until today. According to the GPhA website they represent "the manufacturers and distributors of finished generic pharmaceutical products, manufacturers and distributors of bulk active pharmaceutical chemicals, and suppliers of other goods and services to the generic pharmaceutical industry. GPhA members manufacture the vast majority of all affordable pharmaceuticals dispensed in the United States. Our products are used in nearly two billion prescriptions every year."

    Their Board of Director’s and Executive Committee is a who’s who of generic pharmaceutical manufacturers. Go figure.

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  • Wanna’ tell the FDA about drug shortages? Here’s how

    Here’s the contents of a email I received today from ASHP in regards to drug shortages and the FDA:

    image
    The Food and Drug Administration Wants to Hear How Drug Shortages Impact Patients

    The Food and Drug Administration has opened a comment period to gain insight about the causes and impact of drug shortages. The agency is seeking feedback as a follow up to a public workshop on the impact of shortages.

    You know first-hand the devastating effect that drug shortages are having on patient care.  Today, ASHP’s Drug Shortages Resource Center lists 208 shortages. That’s nearly the same number of shortages that were reported in all of 2010.

    This is your chance to speak up.

    Write a letter to the FDA that describes your experiences and challenges managing drug shortages.  Here’s what you should include:

    • Impact on patient care.  Share examples from your practice site, such as patients who’ve had to delay care or who’ve experienced adverse affects from second-line therapies.

    • Impact on pharmacy department operations: Discuss how the time spent researching availability of drug products and the redeployment of pharmacists from patient care roles affects the pharmacy department.

    Be sure to ask your colleagues in the pharmacy department as well as your nursing and physician colleagues to join you. Enlist your patients as well. Every voice counts!

    The deadline to submit comments is December 23, 2011. You can post comments on www.regulations.gov or send comments to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm.1061, Rockville, MD 20852.  See the Federal Register notice for more details.

    Your input and expertise are not only welcome, they are essential to achieving a solution to this critical issue.

    Use the resources below to familiarize yourself with ASHP’s messages on drug shortages.