INNOVATIONS in pharmacy Inspiring Inquiry and Improvement in Pharmacy Practice, Education, and Policy. A quarterly publication featuring case studies, clinical experiences, commentaries, idea papers, original research, review articles, and student projects that focus on leading edge, novel ideas for improving, modernizing, and advancing pharmacy practice, education, and policy. INNOVATIONS in pharmacy. University of Minnesota Libraries Publishing en-US INNOVATIONS in pharmacy 2155-0417 <p>Copyright of content published in <em>INNOVATIONS in pharmacy</em>&nbsp;belongs to the author(s).</p> Mapping Impossible Utilities: The ICER Report on Tezepelumab for Severe Asthma <p>The focus of this commentary is on the attempt to create EQ-5D-3L ordinal preferences from a disease specific asthma questionnaire, the Asthma Quality of Life Questionnaire (AQLQ). The question is whether it is possible from the perspective of fundamental measurement to create a simple linear algorithm to map AQLQ scores to EQ-5D-3L preferences. It is proposed that this is mathematically impossible as the aggregate AQLQ score is ordinal, apart from the fact that the AQLQ is a multiattribute score that lacks construct validity and any pretense to having interval properties. Disallowing the mapped utilities means that the modelling cannot be sustained. It is proposed that the focus should be on single attribute measures of the latent construct “need fulfillment quality of life”. These measures would meet the required standards of Rasch Measurement Theory (RMT) applying simultaneous conjoint standards of measurement theory, as well as capturing the patient voice.</p> Paul C Langley Copyright (c) 2022 Paul C Langley 2022-05-24 2022-05-24 13 2 1 1 10.24926/iip.v13i2.4455 Use of an Innovative Pharmaceutical Class Scoring Tool for Prioritized Annual Formulary Review <p><strong>Background: </strong>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.</p> <p><strong>Objective: </strong>To create a prioritization system for annual formulary review through development of a pharmaceutical class scoring tool.</p> <p><strong>Methods: </strong>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.</p> <p><strong>Results: </strong>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.</p> <p><strong>Conclusions: </strong>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.</p> Holly Sheldon Audrey Kostrzewa Shannon Werner Terry Audley Adam Biggs Taylor Mancuso Mary Frances Picone Copyright (c) 2022 Holly Sheldon, Audrey Kostrzewa, Shannon Werner, Terry Audley, Adam Biggs, Taylor Mancuso, Mary Frances Picone 2022-06-15 2022-06-15 13 2 7 7 10.24926/iip.v13i2.4785 A Pharmacist-Driven Education and Intervention Program that Improves Outcomes for Hypertensive Patients <p><strong>Purpose</strong>: Uncontrolled hypertension is serious and may lead to severe cardiovascular events and death. To better educate and empower patients to meet their blood pressure (BP) management goals, a large, integrated academic healthcare system implemented the Blood Pressure Goals Achievement Program (BPGAP), a longitudinal intervention embedding community pharmacists within healthcare teams. This study evaluated BPGAP on its ability to promote patient BP management goals.</p> <p><strong>Methods</strong>: A pre-/post-intervention analysis was conducted whereby BP measurements were evaluated longitudinally within acuity groups determined by k-means clustering. Generalized linear mixed models evaluated trends in BP by time period, and proportions of patients meeting BP management goals (&lt;140/90 mmHg) were assessed in relation to BPGAP enrollment date.</p> <p><strong>Results</strong>: There were 5,125 patients who were clustered into Uncontrolled, Borderline, and Controlled blood pressure groups; 2,108 patients had BP measurements across 4 time periods before and after BPGAP enrollment. Groups differed by patient age, sex, and other demographics (p&lt;0.0001). Patients in the Uncontrolled and Borderline BP clusters demonstrated significant BP decreases after BPGAP enrollment, continuing at least to 1-year post-intervention; Controlled cluster patients maintained BPs throughout the study period. The proportion of patients with controlled BPs increased from 56% immediately pre-BPGAP to 74% in the 3- to 6-months following enrollment.</p> <p><strong>Conclusion</strong>: BPGAP is effective at helping patients achieve their BP management goals. Pharmacists may play a key role in hypertension control through measuring BPs and including updates and recommendations in the electronic health record, educating patients, and engaging in communication with healthcare teams.</p> Alicia Zagel Adam Rhodes Jeri Nowak Amanda Brummel Copyright (c) 2022 Alicia L. Zagel, PhD, MPH, Adam Rhodes, MS, Jeri Nowak, PharmD, BCPS, Amanda R. Brummel PharmD, BCACP 2022-05-25 2022-05-25 13 2 2 2 10.24926/iip.v13i2.4570 Antifungal Drugs Shortage in India amidst Looming Increase in Invasive Fungal Infections among COVID-19 Patients: An Impending Crisis <p>The widespread prevalence of fungal infections in the second wave of COVID-19 pandemic could be owed to ubiquitous and injudicious use of steroids and immunosuppressive nature of the virus. However, these fungal infections also meant increased use of antifungal drugs, hence endangering their supply. Amphotericin B is the first line drug for mucormycosis which was declared as an epidemic in India during the second wave. With the increasing demand of the drug, came challenges to manufacture and supply large quantities of the drug and exploitation by creating a black market and spread of false information and imprudent usage. It is of utmost importance to be prepared with adequate supply all over the nation and implementing safety regulations in manufacturing and supply of large quantities of drugs during the demanding times and make them accessible at a reasonable rate.</p> Behram Khan Ghazi Usman Zahid Muhammad Abdullah Usman Zohra Kazmi Reem Hunain Mehr Muhammad Adeel Riaz Osman Kamal Osman Elmahi Mohammad Yasir Essar Mohammad Mehedi Hasan Copyright (c) 2022 Behram Khan Ghazi, Usman Zahid, Muhammad Abdullah Usman, Zohra Kazmi, Reem Hunain, Mehr Muhammad Adeel Riaz, Osman Kamal Osman Elmahi, Mohammad Yasir Essar, Mohammad Mehedi Hasan 2022-05-25 2022-05-25 13 2 3 3 10.24926/iip.v13i2.4480 Residency Applicant Perceptions of Multiple Mini Interviews in Post-Graduate Year 1 Residency Interviews <p><strong>Introduction</strong>: Residency interviews offer an opportunity for both candidates and programs to evaluate whether the pairing is a good fit. Multiple mini interviews (MMIs) have been incorporated into interviews for medical training as a way to evaluate non-cognitive abilities. </p> <p><strong>Objectives</strong>: To determine how candidates perceived the interview process at our institution, specifically related to the MMIs. </p> <p><strong>Methods</strong>: This retrospective review evaluated candidates’ perceptions of traditional interviews and MMIs through post-interview surveys over a 3-year period. Candidates evaluated the interview activities, time allowed for MMIs, and overall impression of the program during the 2-week period between submitting rank lists and the release of match results. Survey results are reported using descriptive statistics. Candidate perceptions on their ability to showcase skills in different types of interviews was evaluated with chi-square test.</p> <p> <strong>Results: </strong>The interview day increased the desire to pursue residency at our institution for 88% of candidates. Candidates reported similar ability to showcase skills developed during pharmacy school through the clinical and patient education MMIs compared to traditional interviews; however, they did not feel the collaboration MMI showcased their abilities as well as traditional MMIs. </p> <p> <strong>Conclusion: </strong>The introduction of MMIs to the residency interview day were perceived positively by most candidates and allowed candidates to showcase abilities in a different manner from traditional interviews. </p> Jennifer Szwak Shannon Rotolo Hailey P. Soni Copyright (c) 2022 Jennifer Szwak, Shannon Rotolo, Hailey P. Soni 2022-06-06 2022-06-06 13 2 4 4 10.24926/iip.v13i2.4806 Impact of Ambulatory Care Pharmacist-Led Diabetes Mellitus Management on Hemoglobin A1c Values Among Patients With Diabetes in a Primary Care Clinic Over Two Years <p><strong>Background:</strong> Previous evaluation in the literature of ambulatory care pharmacist management on glycosylated hemoglobin (HgbA1c) has been positive, but often limited to 6 to 12 months of follow up. </p> <p><strong>Objective:</strong> The objective of this study is to evaluate the impact of an ambulatory care pharmacist on HgbA1c among patients with diabetes in a primary care clinic over two years.</p> <p><strong>Methods:</strong> Retrospective chart review was conducted on patients with type 2 diabetes managed by the ambulatory care pharmacist. Patients with at least one HgbA1c value ≥7% in the two-year pre-intervention period were included. The primary outcome was the change in mean HgbA1c from baseline to two years post-intervention. The secondary outcome was the change in mean of all HgbA1c values over two years pre-intervention compared to two years post-intervention.</p> <p><strong>Results:</strong> Data for 116 patients was analyzed two years prior to and two years after ambulatory care pharmacist service initiation. The mean HgbA1c at baseline pre-intervention was 8.8% compared to a mean HgbA1c of 7.8% two years post-intervention. A total of 12.9% of patients (n=15) had a baseline HgbA1c of less than 7% pre-intervention, compared to 42.2% of patients (n=49) two years post-intervention (p&lt;0.001). The overall mean HgbA1c was 8.8% in the two-year pre-intervention period and 8.2% in the two-year post-intervention period (p&lt;0.001). Among patients with an overall mean HgbA1c ≥8% in the pre-intervention period, the mean HgbA1c was 9.8% pre-intervention and 8.7% post-intervention.</p> <p><strong>Conclusion: </strong>Ambulatory care pharmacist interventions demonstrated a significant impact on HgbA1c reduction over two years of follow up.</p> Insaf Mohammad Julie George Jonathan Zimmerman Ruaa Elteriefi Copyright (c) 2022 Insaf Mohammad, Julie George, Jonathan Zimmerman, Ruaa Elteriefi 2022-06-08 2022-06-08 13 2 5 5 10.24926/iip.v13i2.4815 The Role of Pharmacists in Strengthening the Health System in Nigeria <p>The role of Pharmacists in healthcare has changed significantly over the previous half-century, from dispensing to providing direct patient-oriented services unrelated to dispensing. As a result, the pharmacy profession offers unique expertise to members of the profession with a distinct set of abilities that enable them to play a variety of roles in developing the Nigerian health system. Pharmacy and community pharmacists play an important role in the public health system by providing prescription and over-the-counter (OTC) medication with professional counseling, participating in health care programs, and maintaining contact with other healthcare professionals in the health care system. In addition to being open to the public, pharmacists are responsible for the safe and effective administration of pharmaceuticals, participate in health screening and monitoring programs, and are responsive to the requirements and preferences of patients. Unfortunately, there are fewer studies on the roles that pharmacists play in improving the Nigerian health system. As a result, this study highlights some of the roles pharmacists play in strengthening the health system of Nigeria.</p> <p> </p> Habeebullah Oladipo Abdulbasit Muili Yusuf Rashidat Abdulmalik Rokibat Copyright (c) 2022 Habeebullah Oladipo, Abdulbasit Muili, Yusuf Rashidat, Abdulmalik Rokibat 2022-06-14 2022-06-14 13 2 6 6 10.24926/iip.v13i2.4763