community impact
tobacco Quit-Lines. Chewning also worked with physician and pharmacist dyads to refer individuals with complicated regimens to a community pharmacist for MTM consultations. This referral process reinforced the legitimacy of the pharmacists’ delivery of MTM. Chewning teaches students to follow planning steps when developing interventions. These include conducting SWOT analysis, comparing options, identifying relevant literature, writing objectives, describing the intervention, flowcharting the preparation process preceding implementation, conducting a cost/benefit analysis, developing a quality improvement plan, testing the service and summarizing what revisions are needed. Deciding which interventions are needed is based on pharmacy experiences and reviews of the research literature on patient needs. The dose orchestration approach originated in part when Chewning had to help her husband manage his complicated medication schedule. One of her students undertook the Quit Line referral study as part of her dissertation, which involved a randomized controlled trial with 16 Walgreens pharmacies. “Each year the student pharmacists in my course plan and pilot tests of services with about 20 community pharmacies,” she noted. “Pharmacists are an important, underused resource that patients need to help them manage their medications effectively. The challenge is to help patients understand what pharmacists can offer, and to help pharmacists understand how grateful patients would be to receive this help.” P Jane Rooney is a freelance writer based in Oakton, Va.
Interventions From Bench to Bedside By Kirsten F. Block Although all interventions are aimed at improving health and patient care, some interventions begin long before a healthcare team interacts with a patient. In some cases, interventions can start in the laboratory, far from direct interaction with patients but always with patients in mind. And when society encounters health crises, this “all hands on deck” approach to interventions can have a huge impact on improving patient outcomes. To explore how basic research synergizes with practice interventions to improve health and the quality of care, and how the academic pharmacy community is making critical contributions in these indirect patient interventions, look no further than the opioid epidemic. Without a doubt, research at colleges of pharmacy—some of which was highlighted in a December 2016 feature in Academic Pharmacy Now—has enhanced our understanding of the epidemic’s impact and continues to seek new ways to address it. With the rate of prescription painkiller use climbing dramatically in recent decades, a diverse array of tools and interventions are needed to combat the consequences. One such tool already employed to curb abuse and misuse of opioids stems from basic research in drug delivery technology by Dr. James W. McGinity of The University of Texas at Austin. Using a process called hot-melt extrusion, a technique that has long been utilized by the plastics industry but has only recently gained momentum in the pharmaceutical industry, McGinity, a professor emeritus and the Johnson and Johnson Centennial Chair Emeritus in Pharmacy, and his then-graduate student, Dr. Feng Zhang, were able to fuse the active drug component of OxyContin with a polymer carrier that produced a nearly indestructible OxyContin tablet. Just how does this technology translate to patient outcomes? The new formulation creates tablets strong enough to survive a direct blow by a hammer while remaining intact, greatly reducing the risk of a pill being crushed and snorted. The tamper-proof design also prevents extraction of the active component in water, diminishing the ability to inject the drug into the bloodstream. By tackling two common paths for opioid abuse, McGinity’s technology has the potential to reduce the number of opioid overdoses and save many lives. In recognition of this and his many other advances in drug delivery technology, McGinity was recently inducted as a fellow of the National Academy of Inventors. As a result of McGinity’s research, OxyContin was reintroduced to the market in a new abuse-deterrent form around 2010. It was the first abuse-deterrent formulation approved by the U.S. Food and Drug Administration, and since its initial rollout, a handful of other abuse-deterrent opioids have received FDA approval. Although not completely abuse-proof, abuse-deterrent formulations have become a valuable asset in combatting one aspect of the opioid epidemic, and their inclusion in the FDA’s Opioid Action Plan is a reminder of the ways in which innovation at the bench can shape patient interventions. Kirsten F. Block is Associate Director of Research and Graduate Programs at AACP.
Academic Pharmacy NOW 2017 Issue 3
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