Natalia Shcherbakova

Clinical pharmacist home visits and 30-day readmissions in Medicare Advantage beneficiaries

RATIONALE, AIMS & OBJECTIVES A variety of transition of care interventions has been evaluated to date to reduce readmissions. No studies evaluated effectiveness of clinical pharmacists home-visits to recently discharged Medicare Advantage patients with the goal of preventing subsequent readmissions and urgent care use. The objective of this study was to evaluate the effectiveness of in-home clinical pharmacists transition of care program on 30-day all-cause readmissions, emergency department (ED) visits, outpatient visits, as well as to assess patient satisfaction with the program. METHODS The study used retrospective cohort design. RESULTS A total of 245 patients were included in the study (mean (SD) age 77.8 (8.7); mean Charlsons Comorbidity Index 5.0 (2.5); 53.5% male). Forty-seven patients (19.0%) experienced at least one ED visit and twenty-two patients (9.0%) were readmitted within 30 days. The two groups did not differ on available demographic and clinical characteristics (p > 0.05). There was no difference in 30-day readmission rates, percent of patients with ≥1 ED visit, ≥1 outpatient physician office visit between the groups (p > 0.05). A total of 78 program participants responded to a satisfaction survey with 95% agreeing the program helped to stay healthy at home. CONCLUSION Multiple medication-related problems were identified by in-home pharmacists and the program appeared to be well-accepted by participants. In this study we did not find that the program had an impact on reduction of inpatient or urgent healthcare use. Further research using a different study design and a larger sample to estimate the program effectiveness is warranted.

The Role of authorized generics in the prescription drug marketplace

Authorized generics continue to be a controversial phenomenon in the contemporary pharmaceutical marketplace. Proponents of authorized generics consider them an additional player in a healthy competitive pharmaceutical market environment, while opponents note that the entry of authorized generics may be considered anticompetitive under certain circumstances. This study investigated the market share dynamics associated with authorized generics and their direct competitors during the crucial period of initial generic(s) entry. At the end of the 12 months of generic presence, market shares for authorized generics launched with the 180-day marketing exclusivity of an independent generic in the cases of Zocor®, Proscar® and Norvasc® were 37, 52 and 49 per cent, respectively. Meanwhile, market shares for authorized generics launched without the 180-day marketing exclusivity of an independent generic in the cases of Arava® and Ambien® were 21 and 18 per cent, respectively. Authorized generics launched during independent generic 180-day marketing exclusivity dominated the market and had the largest market share when compared to any other single market participant for the case. In the long run, authorized generics might discourage independent generic companies from timely generic introductions. Policy limiting the entry of an authorized generic during the 180-day marketing exclusivity of an independent generic might prevent delayed generic entry.

Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder:

Background: Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use. Objective: We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy. Methods: The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence. Results: A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76). Conclusions: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.

Pharmaceutical industry in a global context elective course: implementation and preliminary outcomes

To describe the implementation of ‘Pharmaceutical Industry in a Global Context’ elective in a 4‐year US pharmacy programme.

Assessment of Pharmacy Manpower and Services in New England

Objectives: This study assessed longitudinal trends in pharmacy staffing and services in the 6 New England states by comparing survey results from 2008 and 2013. Methods: A validated 32-item survey was mailed in 2008 and 2013 to a random sample of 2000 pharmacists. Each sample represented approximately 15% (2008) and 13% (2013) of the active rosters. Results: Response rates were 24% in 2008 and 23% in 2013. In all, 45% of 2013 respondents reported a pharmacist position vacancy in the past 12 months versus 62% in 2008. In all, 12% of 2013 respondents agreed or strongly agreed with a statement regarding pharmacists’ shortage versus 77% in 2008. Disease management services were reported to be offered by 23% of 2013 respondents versus 28% in 2008. Reasons for not offering the services in 2013 included the lack of staffing (61%), expertise (28%), and reimbursement (29%). In 2008, these results were 74%, 33%, and 31%, respectively. Conclusions: The pharmacist shortage within New England was alleviated during 2008 to 2013. Participation of pharmacists in disease management services did not follow staffing trends as fewer pharmacists reported providing services. Key barriers to services provision persist and consideration of how to resolve them (medication therapy management reimbursement and additional education) should be explored.