Assessing the impact of a leadership and advocacy elective course in a college of pharmacy curriculum.

INTRODUCTION AND LEADERSHIP FRAMEWORK: While the scope of a pharmacist's work has grown, continued advocacy is needed to ensure that their skillset is used to the best advantage of the patient. To accomplish this aim, the University of Utah College of Pharmacy created an elective advocacy and leadership class to train students in leadership and advocacy methods, with a focus on enabling students to practice advocacy within the state of Utah throughout the class. EDUCATIONAL CONTEXT AND METHODS: In addition to traditional lectures, this class asked students to apply the knowledge learned in class to projects within their sphere of influence. Activities included drafting their own bill, writing to a legislator, attending state legislative and board of pharmacy meetings, and a longitudinal quality improvement project. Students answered a pre- and post-class survey to assess their attitudes towards advocacy efforts and how those attitudes were affected by participation in the class. FINDINGS AND DISCUSSION: As expected, a positive change in attitude towards advocacy was observed, and students indicated that they were more likely to engage in advocacy activities in the future after participating in the course. Moreover, a real legislative outcome has been observed as the result of class projects. IMPLICATIONS: Enabling students to engage in advocacy activities and guiding them to effect real change is a valuable technique in pharmacy education. Similar efforts can be replicated in other institutions, and similar training should be expanded to required portions of the pharmacy curriculum.

Assessing the impact of a payor-funded embedded clinical pharmacist on patient and provider satisfaction in a private primary care practice.

PURPOSE: With expanding roles of clinic-embedded pharmacists comes the need to identify routes for optimization, soliciting and addressing feedback, and justifying the position(s) to the employing institution. Studies have demonstrated the benefit of integrating pharmacists into healthcare teams, but these opportunities remain largely limited to major health systems due to a lack of billing avenues for and familiarity with the services pharmacists can provide. METHODS: With funding from and partnership with a third-party payor, a pharmacist was incorporated into a private physician-owned clinic to be a resource to the providers and provide comprehensive medication management to patients. Patient and provider experiences were assessed by survey and interview, respectively, utilizing both Likert-scale and free-response questions. The responses were coded, analyzed, and aggregated into themes. The demographic and Likert-scale responses were analyzed using descriptive statistics. RESULTS: Patients reported a high level of satisfaction with the pharmacist's service, indicating that they felt more comfortable managing their medications and that they would recommend the pharmacist to a family member or friend. Provider satisfaction was also high, with providers stating that they found the recommendations by the pharmacist helpful, that the recommendations improved cardiovascular risk factors in their patients with diabetes, and that, overall, they were satisfied with the care provided by the pharmacist. The primary concern from the providers was a lack of understanding regarding how best to reach and utilize the service. CONCLUSION: Overall, an embedded clinical pharmacist providing comprehensive medication management at a private primary care clinic had a positive impact on both provider and patient satisfaction.

Identifying key roles of the pharmacy technician in primary care settings.

PURPOSE: As the pharmacist's role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist's professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature. METHODS: The duties of primary care pharmacy technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians. RESULTS: Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects. CONCLUSION: Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

Abuse-Deterrent Opioid Formulations and the Opioid Crisis: A Pharmacist's Perspective.

BACKGROUND: For over 20 years, the United States has suffered the detrimental effects of an opioid epidemic. Extended-release opioid products are particularly prone to abuse due to the high amount of opioid present. By bypassing the controlled-release mechanisms and nonoral administration, individuals experience intense and dangerous "highs." Abuse-deterrent opioid formulations have been recommended as a potential solution to the crisis, but widespread utilization has been stunted and their role in therapy remains unclear owing to limited real-world efficacy data and affordability issues. This review discusses abuse-deterrent opioid formulations, the mechanisms and data underlying available products, and a pharmacist's perspective of their role in the opioid crisis. METHODS: The authors reviewed PubMed, MEDLINE, and Google Scholar electronic databases for premarketing and postmarketing studies on OxyContin, Xtampza ER, and Hysingla ER. RESULTS: Studies showed lower rates of abuse (19% reduction), opioid use disorder (27%), overdose (34%), and fatalities (85%) with the reformulated OxyContin when compared with the original product and comparator opioids. However, these studies revealed the potential for bypassing abuse-deterrent mechanisms and diverting abuse to other drugs. Postmarketing studies are unavailable for Xtampza ER or Hysingla ER, although premarketing studies suggested that some controlled-release properties persist when the product is manipulated, indicating that abuse may be more difficult and less rewarding. CONCLUSIONS: Abuse-deterrent opioid products may lead to reductions in abuse, overdose, and overdose fatalities. However, cost, loopholes in deterrence mechanism, and possible diversion to other substances hinder their role in the opioid crisis. Multiple approaches must be used to improve opioid safety, and further postmarketing and real-world analyses should be performed on available opioid formulations to assess their impact on abuse-related adverse events.