Use of an Innovative Pharmaceutical Class Scoring Tool for Prioritized Annual Formulary Review.

Background: Though The Joint Commission requires health systems perform annual formulary review, guidance for how to perform this review is lacking. Published methods include comprehensive review of all pharmaceutical classes; however, this approach may not be the most efficient or effective option for a health system with a large formulary. Objective: To create a prioritization system for annual formulary review through development of a pharmaceutical class scoring tool. Methods: Drug information pharmacists developed the scoring tool, which used external and internal data to score pharmaceutical classes in 4 categories: safety, efficacy, cost, and utilization. The primary outcome, number of formulary changes resulting from pharmaceutical class review, was compared between the highest-scoring and lowest-scoring class to assess the tool's ability to prioritize high-yield class reviews. Results: The tool calculated scores for 91 pharmaceutical classes, altogether containing 962 medications. After review of the highest-scoring class, corticosteroids, 2 formulary changes were made: one dosage form was removed from formulary, and one medication was restricted to outpatient use only. Zero formulary changes resulted from review of the lowest-scoring class, pharmaceutical adjuvants. Conclusions: The tool described in this study prioritized annual formulary review efforts by identifying a pharmaceutical class with meaningful formulary optimization opportunities as the highest-scoring class, while correctly identifying a class with no optimization opportunities as the lowest-scoring class.

Optimization of REMS Program Compliance in a Large Academic Health System.

Ensuring compliance with all applicable Risk Evaluation and Mitigation Strategies (REMS) programs within a health system is challenging. These FDA-mandated programs are numerous, unique, and ever-changing. Actions require several stakeholders and moving parts. In addition, the effectiveness and impact of these programs has been challenged and is not always clear, which hampers buy-in and therefore compliance. F&MCW is a health network in southeastern Wisconsin that includes five hospitals and almost 40 clinics. Since 2014, several system-wide approaches to medication use, including formulary alignment and REMS program optimization, have taken place with an over-arching goal of providing efficient, safe, and consistent care for the patients and populations served. This manuscript describes the steps that took place over the past six years or so related to REMS program optimization. It also offers practical tips for other health systems based on lessons learned through this one institution's experiences.

Implementation and Evaluation of Near-Peer Facilitated Journal Club Activities in a Required MLE Course Series.

Objective. To describe and evaluate the implementation of multiple, content-integrated journal club activities into a large, required medical literature evaluation (MLE) two-semester course series using near-peer student facilitators. Methods. Using near-peer, third-year (P3) students as a significant source of instructional personnel, 10 journal club activities were incorporated annually into the second-year (P2) MLE series. Activities included preparation, quiz, journal club, and debriefing. Each activity divided the P2s into groups of 8-12 students. In the fall semester, journal clubs were facilitated by faculty members and near-peers as P2s participated. In spring, P2s also facilitated, while faculty members' and near-peers' roles shifted to providing rubric-facilitated feedback and mentoring. Near-peers and P2s provided feedback on the experiences. Results. Over four years, two course faculty members and 62 near-peers facilitated (fall) or provided feedback/mentoring (spring) for 346 P2 MLE I/II students in 419 individual journal clubs. Course faculty members covered 80 journal clubs, while near-peers covered 339. Faculty and near-peer ratings of P2 facilitators demonstrated good P2 preparation. P2 facilitators were best at facilitating discussion of implications and results, while being most challenged by introduction and methods. P2 survey responses highly favored the addition of journal club activities and the use of P3 near-peer facilitators. Conclusion. The use of near-peers in the implementation of integrated journal club activities in a large, required MLE course series was successful. Future study will include refining formative feedback processes, exploring benefit to near-peers, and exploring near-peer use in other didactic settings.