Implementing and Optimizing Biosimilar Use at Mayo Clinic.

OBJECTIVE: To determine whether the formation of a multidisciplinary team, pharmacist-led therapeutic interchange, and streamlined electronic health record optimization improved biosimilar adoption throughout Mayo Clinic. PATIENTS AND METHODS: The project focused on the use of reference products and biosimilars for 5 biologics-bevacizumab, epoetin alfa, filgrastim, rituximab, and trastuzumab-at all Mayo Clinic locations. Pharmaceutical wholesale purchase histories of those reference products and biosimilars were assessed from September 1, 2020, through August 31, 2021, and compared with data from September 1, 2019, through August 31, 2020. Formulary decisions were implemented across 5 biologics for most ordering pathways on September 1, 2020. Pharmaceutical purchased drug units and expenditures were tracked at 3-month intervals for conversion to formulary-preferred contracted biosimilars. RESULTS: In the final postimplementation period, the absolute percentage increase of formulary-preferred biosimilars was 69% for bevacizumab, 63% for epoetin alfa, 80% for filgrastim, 79% for rituximab, and 72% for trastuzumab. Pharmaceutical line item savings in the 12-month postimplementation period totaled $23.1 million across all 5 biologics. CONCLUSION: Creation of a multidisciplinary team to implement formulary-preferred contracted biosimilars led to the adoption of biosimilars throughout Mayo Clinic with considerable pharmaceutical line item savings.

The long-term impact of providing nursing education in a low-income country.

OBJECTIVE: To measure long-term knowledge gain after provision of nursing education in a low-income country. DESIGN AND SAMPLE: Global health education research has often focused on the short- term effects of providing education and direct patient care. Assessment of long-term knowledge gain is key for determining whether education knowledge transfer is sustainable. MEASUREMENTS: This prospective cohort study of educational training for nurses in Haiti tested knowledge gain before, immediately after, and 6 months after education. INTERVENTION: Quantitative assessments were obtained through multiple choice tests at 3 time points. Qualitative data were obtained through focus groups and self-assessments. RESULTS: Knowledge gain was significant from pretest to immediate posttest, and knowledge retention was assessed at 6 months after the education. Qualitative data showed improvement in reported confidence levels and patient care activities. Short-term knowledge gain was statistically significant for improvement; however, long-term knowledge gain was statistically significant in only 4 of 19 lectures. CONCLUSIONS: Reported qualitative improvements in patient care indicated added value of providing education to the nursing staff. Hands-on learning techniques were important to long-term retention, and building trust was vital to the completion of our study.

Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti.

BACKGROUND: In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. OBJECTIVE: We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. DESIGN: We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. RESULTS: The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of 'real-time' medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. CONCLUSIONS: An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.