Pharmacist Contributions to the U.S. Health Care System

Objective: The overall goal for this study was to conduct a segment analysis of the pharmacist workforce during 2009 based upon time spent in medication providing and in patient care services. Methods: Data for this study were obtained from the 2009 National Pharmacist Workforce Survey in which a random sample of 3,000 pharmacists was selected. Cluster analysis was used for identifying pharmacist segments and descriptive statistics were used for describing and comparing segments.Results: Of the 2,667 surveys that were presumed to be delivered to a pharmacist, 1,395 were returned yielding a 52.3% overall response rate. Of these, 1,200 responses were usable for cluster analysis. Findings from this study revealed five segments ofpharmacists: (1) Medication Providers, (2) Medication Providers who also Provide Patient Care, (3) Other Activity Pharmacists, (4) Patient Care Providers Who also Provide Medication, and (5) Patient Care Providers. The results showed that, in 2009, 41% of U.S. pharmacists were devoted wholly to medication providing (Medication Providers). Forty-three percent of pharmacists contributed significantly to patient care service provision (Medication Providers who also Provide Patient Care, Patient Care Providers who also Provide Medication, and Patient Care Providers) and the remaining 16% (Other Activity Pharmacists) contributed most of their time to business / organization management, research, education, and other health-system improvement activities. Conclusions: Based on the findings, we propose that the pharmacy profession currently has, and will continue to build, capacity for contributing to the U.S. health care system in new roles for which they have been identified. However, as shifts in professional roles occur, a great deal of capacity is required related to new service provision. Resources are scarce, so an understanding of the most appropriate timing for making such changes can lead to cost-effective use of limited resources for improving patient care

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Valuable Lessons for Pharmacist PBRNs: Insights and Experiences from Physician PBRN Members

Practice-based research networks (PBRNs) rely on a cadre of engaged members to participate in research projects. As pharmacist PBRNs increase in number, it is helpful to understand how members of other professions view their own participation in PBRNs and potential collaborative research endeavors with pharmacists. Due to their longer history of PBRN experience, physician PBRN members may have helpful advice for the establishment of pharmacy networks. The objectives of this study were to describe perceptions among a group of physician PBRN members about: Advice for developing a pharmacist PBRN, practice aspects that might benefit from collaborating with pharmacists who are part of a PBRN, and benefits and challenges of PBRN member participation. This study employed qualitative research methods. Semi-structured interviews were conducted with physician members of the Oklahoma Physicians Resource/Research Network, a primary care PBRN. Advice for establishing a pharmacist PBRN included identifying a champion, recruiting a core group, and conducting a needs assessment. Collaborative areas of interest included medication use management, patient education on chronic disease states, and physician education on new therapies. Participation benefits were categorized as personal satisfaction, improvement in practice quality improvement, advancement of specialty, peer interaction and learning, and real-time information and support. These findings offer insight into strategies for developing and sustaining pharmacist PBRNs and may inform pharmacist PBRN initiatives related to development, member recruitment and retention, and interprofessional project planning with physician PBRNs

A Cognitive Support System to Scaffold Students’ Problem-based Learning in a Web-based Learning Environment

An experimental study was conducted to investigate the effects of question prompts and peer review on scaffolding students’ problem-based learning in a web-based cognitive support system. Ninety-six pharmacy students were randomly assigned to a treatment or control condition. The students in both conditions were asked to generate solutions to a real-world problem on clinical communication in a web-based learning environment. The results indicated that students who received question prompts significantly outperformed those who did not in each of the five problem-solving steps in both initial and revised reports. The results also showed that students in both conditions significantly improved their problem solving scores given a chance to revise their initial problem-solving reports. In addition, the study revealed a positive effect of the expert modeling mechanism in supporting students’ reasoning and problem solving processes. Implications are discussed for designing web-based scaffolds to support students’ problem-solving processes