Roger A. Edwards

Potential Cost Avoidance of Pharmacy Students’ Patient Care Activities During Advanced Pharmacy Practice Experiences

Objectives. To evaluate the potential cost avoidance of student interventions documented by fourth-year (P4) student pharmacists during advanced pharmacy practice experiences (APPEs) in outpatient and inpatient settings. Methods. The school-wide Web-based intervention database was retrospectively analyzed to review characteristics of interventions documented during the 2011-2012 APPE cycle. Potential cost avoidance for interventions was derived from a comprehensive literature review and adjusted to 2011 dollars based on the consumer price index for medical care. Results. Eighty-seven students (71% of the graduating class) documented 5,775 interventions over 36 weeks, with an estimated potential total cost avoidance of

Pharmacists as an Underutilized Resource for Improving Community-Level Support of Breastfeeding

908,800. The intervention categories associated with the greatest cost avoidance were prevention of adverse drug events, provider education, and patient education. Conclusions. Fourth-year student pharmacists and their preceptors had a positive impact, contributing to potential cost avoidance in both the inpatient and outpatient pharmacy settings.

Cost effectiveness of a benzodiazepine vs a nonbenzodiazepine-based sedation regimen for mechanically ventilated, critically ill adults

With their highly visible roles in the community, frequent interactions with soon-to-be and new parents, and knowledge of medication safety, pharmacists can be a key component in breastfeeding promotion and support. A review of the literature showed that pharmacists have poor knowledge but positive attitudes toward breastfeeding and that pharmacy practices are variable and mostly guided by personal experience. A review of 58 health professional organizations’ English-language infant feeding/breastfeeding policy statements showed that no US pharmacists’ association has a position statement, as exists for professional pharmacist organizations in Canada and Australia. We explored pharmacists’ interactions with mothers before and after birth and possible opportunities to expand pharmacists’ roles in the promotion and support of breastfeeding. Barriers to meeting unmet needs of breastfeeding mothers were identified in order to plan strategies for implementing programs to address these barriers. Through input obtained from pharmacy and breastfeeding experts and from information available in the published literature, good matches between unmet needs and capabilities were identified in (a) provision of health promotion resources and public awareness campaigns, (b) assistance with purchase of breastfeeding products and pumps, and (c) provision of information, support, and referral related to commonly encountered difficulties as well as medication use during lactation. Absence of adequate breastfeeding knowledge was identified as a crucial barrier. Leveraging pharmacists to address unmet preventive health needs is especially important as we strive to align resources to support healthy behaviors in our current health care delivery environment.

Using Benchmarking Techniques and the 2011 Maternity Practices Infant Nutrition and Care (mPINC) Survey to Improve Performance among Peer Groups across the United States

PURPOSE Nonbenzodiazepine sedation (eg, dexmedetomidine or propofol) may be more cost effective than benzodiazepine (BZ) sedation despite its higher acquisition cost. MATERIALS AND METHODS A cost effectiveness (CE) analysis of noncardiac surgery, critically ill adults requiring at least 1 day of mechanical ventilation (MV) and administered either BZ or non-BZ sedation, that cycled health states and costs daily using a Markov model accounting for daily MV use until intensive care unit (ICU) discharge, was conducted from a third-party perspective. Transition probabilities were obtained from a published meta-analysis, and costs were estimated from best evidence. Sensitivity analyses were run for all extubation and discharge probabilities, for different cost estimates and for the specific non-BZ administered. RESULTS When non-BZ rather than BZ sedation was used, the incremental cost-effectiveness ratio to avert 1 ICU day while MV or while either MV or non-MV was

Maintaining Continuity in Longitudinal, Multi-method Health Interventions Using Virtual Agents: The Case of Breastfeeding Promotion

3406 and

Helping patients articulate end-of-life wishes: a target for interprofessional participation

3136, respectively. The base-case analysis revealed that non-BZ sedation (vs BZ sedation) resulted in higher drug costs (

A Feminist Virtual Agent for Breastfeeding Promotion

1327 vs

Use of an Interactive Computer Agent to Support Breastfeeding

65) but lower total ICU costs (percent accounted for MV need):

A Reflective Teaching Challenge to Motivate Educational Innovation

35380 (71.0%) vs

Expanding pharmacists' roles in breastfeeding support: A pilot study of an online breastfeeding tutorial for student pharmacists

45394 (70.6%). Sensitivity analysis revealed that BZ sedation would only be less costly if the daily rate of extubation was at least 16%, and the daily rate of ICU discharge without MV was at least 77%. The incremental CE ratio to avert 1 ICU day while MV or non-MV was similar between the dexmedetomidine and propofol non-BZ options. CONCLUSIONS Among MV adults, non-BZ sedation has a more favorable CE ratio than BZ sedation over most cost estimates.