Introduction and Impact of a Human Immunodeficiency Virus Education Package on the Knowledge and Confidence of Pharmacists.

Background: Without specific pharmaceutical knowledge in specialist areas such as Human Immunodeficiency Virus (HIV) management, pharmacists may lack the ability and confidence to provide optimal pharmaceutical care and optimization of outcomes. Objective: To develop a pharmacy-specific, foundational HIV education and assessment package, and assess impact on pharmacist knowledge and confidence. Methods: A foundational HIV education package with assessment was developed. Participants' baseline knowledge and self-reported confidence in HIV management were determined via an anonymous online questionnaire. Only participants who completed the pre-education questionnaire were then provided access to the self-paced, online education package. Participants completed a second questionnaire after completion of the package at a time of their choosing, within 2 months of the first questionnaire completion. Both questionnaires were similar in knowledge difficulty and addressed similar clinical domains. Mean differences in knowledge and confidence levels were analyzed, with further subgroup analyses of knowledge categories. Results: A total of 57 pharmacists completed both questionnaires. HIV knowledge was higher post-education compared with pre-education (mean correct score of 83.7% and 56.5% respectively, P < .001). The mean self-rated confidence of pharmacists in managing medications of people living with HIV, was higher post-education (73.3%) compared with pre-education (33.9%) (P < .001). Conclusion: The use of a pharmacy-specific, foundational HIV management education package significantly increased pharmacist knowledge in HIV management and improved self-reported confidence in the management of this specialty area. Future studies should assess the sustained impact of educational materials on pharmacist knowledge and confidence and investigate translation into improved outcomes for people living with HIV.

Acute management of anaphylaxis in pregnancy.

BACKGROUND: Anaphylaxis in pregnancy is rare but can potentially be associated with significant morbidity and mortality for the mother, fetus and neonate. With appropriate and timely management, even severe anaphylaxis can be managed with excellent maternal and fetal outcomes. OBJECTIVE: The aim of this article is to provide an illustrative case and highlight current recommendations for diagnosis and management of acute maternal anaphylaxis, which have recently been reviewed and developed into a guideline by the Australasian Society of Clinical Immunology and Allergy. DISCUSSION: An understanding of management of anaphylaxis in pregnancy is essential knowledge in the general practice setting. The recommended dosage and administration of adrenaline (epinephrine) for anaphylaxis is the same in pregnant and non-pregnant patients: 0.5 mg adrenaline intramuscularly in the mid-outer thigh (or dose of 0.01 mg/kg if <50 kg). The use of adrenaline in maternal anaphylaxis is supported by various international guidelines.

A therapeutic equivalence program: evidence-based promotion of more efficient use of medicines.

OBJECTIVE: The development of an effective therapeutic equivalence program (TEP) through the collaborative support of medical staff, using the principles of disinvestment. DESIGN AND SETTING: A TEP was introduced at Southern Health, a metropolitan health service in Melbourne, in the 2006-07 financial year. Therapeutic classes were selected for the TEP by stakeholder consensus, and a preferred medication for each class was selected on the basis of cost considerations and therapeutic equivalence. New patients were commenced on preferred medicines, but patients receiving another medicine from a therapeutic class included in the program were not automatically switched to the preferred medicine. For the first 4 years of the program, prescribing patterns were monitored, and savings achieved (due to lower prices for and increased use of preferred medicines) were calculated on a monthly basis. MAIN OUTCOME MEASURES: Prescribing trends for preferred medicines, as a measure of acceptance of the TEP, and savings produced by the program. RESULTS: Over the 4-year study period, 11 therapeutic classes were targeted. The use of all preferred medicines increased once they become part of the TEP and a total of $3.16 million was saved. The annual savings increased each year, and the rate of increase was six times that of the increase in patient separations. CONCLUSIONS: The TEP at Southern Health resulted in significant savings. It showed that, by using a collaborative and evidence-based approach, the principles of disinvestment can be applied to use of medicines.