ABSTRACT
OBJECTIVES: To determine the economic feasibility of implementing community pharmacy-based tech-check-tech compared with other common community pharmacy practice models. METHODS: A decision tree analysis compared 4 community pharmacy practice models: (1) historical (pharmacist or technician fills prescriptions and pharmacist gives immunizations); (2) historical with tech-check-tech (technician or certified technician fills prescriptions and pharmacist gives vaccinations); (3) modern (historical model plus medication therapy management [MTM] services); and (4) modern with tech-check-tech (modern model but a technician or certified technician handles all fills). A series of summed Markov models with a 1-year time horizon compared strategies on gross profit with the use of cycles of 1 hour of work attributed to either filling prescriptions, giving vaccinations, or conducting MTM. RESULTS: Based on current MTM volume, the splitting of pharmacist time across all services (modern model) was the most profitable strategy, resulting in approximately $1700 more than the next most profitable approach (historical model). Models incorporating tech-check-tech need significant time to be filled by MTM services, vaccinations, or other billable services to make up for the investment made into pharmacists' time. For these models, the likelihood of conducting a comprehensive medication review (CMR) in a given hour needs to exceed 47% for allocating all pharmacist time to nonfilling functions to be more profitable. Performing targeted medication reviews alone (without the chance of a CMR) was not sufficient to make tech-check-tech a profitable strategy. At the current inputs, billable services of exceeding approximately $18 and $20 per hour are needed for tech-check-tech to be the most profitable model with and without MTM services, respectively. CONCLUSION: Tech-check-tech implementation in the community setting has the potential to be profitable if pharmacist time is adequately scheduled with other billable services. Future research in this area should increase the number of pharmacies included and expand analyses to encompass chain-based community pharmacies.
Subject(s)
Community Pharmacy Services/organization & administration , Medication Therapy Management/organization & administration , Pharmacists/organization & administration , Pharmacy Technicians/organization & administration , Community Pharmacy Services/economics , Decision Trees , Humans , Markov Chains , Medication Therapy Management/economics , Models, Organizational , Pharmacists/economics , Pharmacy Technicians/economics , Professional Role , Time FactorsABSTRACT
Persistent myofibroblast differentiation is a hallmark of fibrotic diseases. Myofibroblasts are characterized by de novo expression of alpha smooth muscle actin (αSMA) and excess fibronectin assembly. Recent studies provide conflicting reports on the effects of tyrosine kinase inhibitor dasatinib on myofibroblast differentiation and fibrosis. Also, it is not fully understood whether dasatinib modulates myofibroblast differentiation by targeting Src kinase. Herein, we investigated the effect of dasatinib on cSrc and transforming growth factor-ß (TGFß)-induced myofibroblast differentiation in vitro. Our results indicated that selective Src kinase inhibition using PP2 mimicked the effect of dasatinib in attenuating myofibroblast differentiation as evident by blunted αSMA expression and modest, but significant inhibition of fibronectin assembly in both NIH 3T3 and fibrotic human lung fibroblasts. Mechanistically, our data showed that dasatinib modulates αSMA synthesis through Src kinase-mediated modulation of serum response factor expression. Collectively, our results demonstrate that dasatinib modulates myofibroblast differentiation through Src-SRF pathway. Thus, dasatinib could potentially be a therapeutic option in fibrotic diseases.
