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OTC/Lifestyle Pearl of the Day: Comfort Ear

: Comfort Ear soothes dry, irritated ears.

Wait 30 seconds for the liquid to fully be absorbed.

If using hearing aid, only use Comfort Ear at night.

Amazon.com: Comfort Ear Natural Moisturizer, 5 fl oz : Health & Household

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Retail

® Pharmacy Technician Clinical Role section is a comprehensive resource for clinical news and expert insights on issues pertaining to retail, community, and independent pharmacists.

Daily OTC Pearl: Comfort Ear

Prezista is an protease inhibitor indicated for the treatment of HIV-1 infection in patients aged 3 years and older.

Treatment-experienced and -naïve adult patients with no darunavir resistance-associated substitutions: 800 mg (2 400-mg tablets) taken with ritonavir 100 mg once daily and with food

: 100 mg/mL oral suspension-75 mg tablets, 150-mg tablets, 400-mg tablets, and 600-mg tablets

The most common clinical adverse drug reactions to Prezista/ritonavir (an incidence equal to greater than 5%) of at least moderate intensity (equal to or greater than grade 2) were abdominal pain, headaches, diarrhea, nausea, rash, and vomiting.

Prezista (darunavir) tablet label (fda.gov)

® HIV Resource Center is a comprehensive resource for clinical news and expert insights on the treatment of HIV, a virus that attacks the body's immune system and, if left untreated, can lead to AIDS.

Infectious Disease

® Infectious Disease Resource Center is a comprehensive resource for clinical news and expert insights on a group of disorders caused by organisms, such as bacteria, viruses, fungi, or parasites.

Hospital

® Pharmacy Technician Clinical Role section is a comprehensive resource for clinical news and expert insights on issues pertaining to hospital and health-system pharmacists.

Daily Medication Pearl: Prezista (Darunavir)

 spoke with Lisa Hines, PQA Chief Quality and Innovation Officer, about new/potential data sources that PQA is exploring to develop future measures.

 We had our hands tied while we're relying only on claims data. There's only so much you can get out with with the claims data. So we're expanding to use pharmacy system data, EHR data laboratory data, immunization registry or other registry data, patient reported data. So it's really opening up the world for us to develop more meaningful measures and get at patient reported and clinical outcome measures.

Videos

It's really opening up the world for pharmacists to develop more meaningful measures and get at patient reported and clinical outcome measures.

Conference

Expanding Pharmacy System Data for Quality Use Measures

Between 2010 and 2018, the rate of hepatitis C virus (HCV) infection in the United States more than quadrupled.

 More than 2 million Americans are estimated to be living with HCV, many unaware they are infected.

The latest viral hepatitis surveillance report from the CDC indicated that infections rose again during 2019. Hepatitis C is a leading cause of liver cancer and primary cause of liver transplants,

 and despite widely available curative, direct-acting antiviral treatments, it remains a major public health issue. Viral hepatitis costs the government, health systems, and patients billions of dollars every year.

 But the US Department of Health and Human Services (HHS) has a strategic plan to eliminate viral hepatitis in the United States, and 340Bs can play a role.

HHS has laid out a national strategic plan to eliminate viral hepatitis over the next 10 years. The plan has adopted the World Health Organization’s definition of elimination: a 90% reduction in acute infections and a 65% reduction in mortality compared with a 2015 baseline. The strategy provides an actionable framework and key performance indicators to eliminate viral hepatitis by 2030 in the United States.

HHS identifies several disproportionately affected populations and challenges related specifically to HCV. Populations at greater risk for HCV infection include American Indian/Alaskan Natives, Black individuals, non-Hispanic individuals, those who inject drugs or have HIV, and those born between 1945 and 1965. Challenges include access to and cost of HCV treatments, injection drug use, lack of awareness regarding infection status, lack of an HCV vaccine; perinatal transmission of HCV; and testing and linkage to care.

The strategy has 5 primary goals with supporting objectives to achieve elimination. These include achieving integrated coordinated efforts across stakeholder groups to collectively address the viral hepatitis epidemic, decreasing hepatitis disparities, establishing more comprehensive national viral hepatitis surveillance and data usage, improving viral hepatitis–related health outcomes, and reducing infections.

The plan identifies “high-impact settings,” in which large portions of at-risk populations receive care. Included in these settings are many 340B-eligible covered entities (CEs), such as community health centers, Federally Qualified Health Centers, Ryan White clinics, and sexually transmitted infection clinics. The proximity of these CEs to disproportionately affected communities makes the 340B program an extremely effective resource in the plan to eliminate viral hepatitis in the United States.

The National Alliance of State and Territorial AIDS Directors is a nonpartisan nonprofit agency representing a coalition of public health officials involved with the administration of HIV and viral hepatitis programs in the United States.

The organization affirms 340B as “an instrumental tool in ending the viral hepatitis epidemic, enabling viral hepatitis programs to expand and improve services, address health equity, and reduce health disparities.”

One of the challenges identified in the strategic plan is access to medication. On average, 340B health systems provide a higher number of medication access programs than non-340B hospitals.

 The cost savings generated by 340Bs provide critical funding for mission-driven organizations to expand health services and improve health outcomes. A 2019 peer-reviewed study conducted a budgetary impact analysis on a multidisciplinary primary care–based HCV treatment program. The findings showed that for every referral of a patient with HCV, the health system would lose $370 without the 340B program and gain $930 in cost savings with the program.

Across the country, CEs use 340B cost savings to expand resources, facilitate access to treatment, improve health outcomes for at-risk populations, and increase testing. In Philadelphia, Pennsylvania, a community health center used cost savings to significantly expand linkage to care for at-risk community members and testing.

 The United States faces a mounting shortage of health care workers,

 and data show that expanding the role of the clinical pharmacist can successfully fill the HCV provider gap and facilitate positive outcomes.

 340B cost savings are often used to integrate clinical pharmacists into care teams. After a significant increase in local HCV infections, a health system in Maine used 340B savings to create a pilot program integrating pharmacists alongside physicians to manage HCV by providing education, medication therapy management, monitoring, and ongoing follow-up. The program increased the number of patients starting treatment for HCV, and 100% of those enrolled in the program completed posttreatment laboratory tests compared with 58.8% of those without pharmacist involvement.

 Pharmacists have also been successful in extending the reach of rural clinics by providing HCV clinical services for disproportionately affected Alaskan Native and Native American populations.

Although the 340B program maintains bipartisan support, there are shortcomings. Critics contend that some health systems are not using cost savings generated through the program to increase care for at-risk or low-income populations.

 Sixteen drug manufacturers have moved to restrict discounts through 340B contract pharmacy arrangements with many health systems, citing lack of oversight in addition to an increase in duplicate discounts and diversion.

 Also, some CEs have come to rely on the cost savings generated through 340B programs to keep their doors open. As lower-cost generics enter the market, 340B cost savings decrease and leave many mission-driven entities at financial risk.

Program integrity has fallen on the shoulders of the CEs. Now more than ever, health systems must draw a clear line showing how 340B cost savings are applied to expand services, improve outcomes, and stretch resources. CEs should also consider financial contingency plans, as generics erode cost savings and leave overleveraged CEs at risk.

Working together with contract pharmacy partners, CEs should also be prepared to provide increased visibility and claims level data demonstrating program integrity to their manufacturer partners.

“Covered entities should critically evaluate and review the compliance processes in place with their contract pharmacy partners,” said Ted Traurig, BioMatrix vice president of specialty pharmacy operations. “Aggressive mock auditing, physically segregated inventories, separate wholesale accounts, and prospective identification of Medicaid claims can go a long way in helping CEs avoid duplicate discounts and diversion.”

The elimination of HCV will require engagement from a wide range of health stakeholders and organizations. The clinical pharmacist role continues to evolve in the health care environment, and pharmacists will play an increasingly active part in overcoming HCV. Although it is not perfect, the 340B program provides significant opportunities and resources to achieve many goals outlined in the HHS plan. Health systems in high-impact settings should critically review the action plan and consider how to best use 340B cost savings to help achieve the goal of eliminating HCV.

 is marketing director/regional care coordinator at BioMatrix Specialty Pharmacy in Plantation, Florida.

1. Hepatitis C basic information. HHS. Accessed April 26, 2022. https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-c-basics/index.html

2. Know more hepatitis. CDC. Updated June 14, 2021. Accessed April 26, 2022. https://www.cdc.gov/knowmorehepatitis/index.htm

3. Viral hepatitis. U.S. Department of Health and Human ServicesHHS. Accessed April 26, 2022. https://www.hhs.gov/sites/default/files/Viral-Hepatitis-National-Strategic-Plan-2021-2025.pdf

4. About us. NASTAD. Accessed April 26, 2022. https://nastad.org/about

5. 340B drug pricing program guidance for viral hepatitis programs. NASTAD. November 2021. Accessed April 26, 2022. https://nastad.org/sites/default/files/2021-11/PDF-340B-Viral-Hepatitis.pdf

6. Rana I, von Oehsen, W, Nabulsi NA, et al. A comparison of medication access services at 340B and non-340B hospitals. 

. 2021;17(11)1187-1892. doi:10.1016/j.sapharm.2021.03.010

7. Jones EA, Linas BP, Truong V, Burgess JF, Lasser KE. (Budgetary impact analysis of a primary care-based hepatitis C treatment program: effects of 340B drug pricing program. 

 2019;14(3):e0213745. doi:10.1371/journal.pone.0213745

8. Case study: how BioMatrix 340B services helped Philadelphia FIGHT increase HCV testing and linkage to care. BioMatrix Specialty Pharmacy. October 2020. Accessed April 26, 2022. https://static1.squarespace.com/static/58d944d2ebbd1aac620cfead/t/6025b182a95517221882cf0d/1613083010534/BMX057.2+%7C+340B+FIGHT+Case+Study+Case+Study-tk-v1.4.pdf

9. Fact sheet: strengthening the health care workforce. American Hospital Association. November 2021. Accessed April 26, 2022. 

https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce

10. Koren DE, Zuckerman A, Teply R., Nabulsi NA, Lee TA, Martin MT. Expanding hepatitis C virus care and cure: national experience using a clinical pharmacist–driven model. 

 2019;6(7):ofz316. doi:10.1093/ofid/ofz316

11. Meeting varied community needs with 340B savings. 340B Health. October 2021. Accessed April 26, 2022. 2021. https://www.340bhealth.org/files/Meeting_Varied_Community_Needs_with_340B_Savings.pdf

12. Geiger R, Steinert J, McElwee G, et al. A regional analysis of hepatitis C virus collaborative care with pharmacists in Indian health service facilities. 

. 2018;9:2150132718807520. doi:10.1177/2150132718807520

13. Minemyer P. Pioneer Iinstitute report calls 340B an ‘increasingly dysfunctional’ program. Fierce Healthcare. March 22, 2022. Accessed April 26, 2022. https://www.fiercehealthcare.com/hospitals/pioneer-institute-report-calls-340b-increasingly-dysfunctional-program

14. King R. J&J to cut off 340B discounts to contract pharmacies starting in May despite lingering legal fight. Fierce Healthcare. March 22, 2022. Accessed April 26, 2022. https://www.fiercehealthcare.com/providers/jj-cut-340b-discounts-contract-pharmacies-starting-may-despite-lingering-legal-fight

Health systems should review HHS’ action plan and determine how to leverage cost savings to help eradicate HCV.

Hepatitis

® Hepatitis Resource Center is a comprehensive resource for clinical news and expert insights on the treatment of a group of distinct diseases that cause inflammation of the liver, including hepatitis A, B, C, and D.

Explore the Role of 340B in Eliminating Hepatitis C

Limited resources, staffing issues and heavy work schedules can lead to burnout. Female pharmacists may be affected disproportionately because they often juggle household and work to a greater extent than their male counterparts. Pharmacists just starting their careers also often experience high levels of burnout because their inexperience means they tend to take longer to complete tasks.

Burnout is defined as emotional exhaustion, a feeling of being detached from other individuals or one’s work, and a reduced sense of accomplishment.

According to the results of a survey on the COVID-19 pandemic’s effect on the mental health of health care workers, the majority of respondents reported experiencing clinically significant psychiatric symptoms, including anxiety (75%), depression (74%), posttraumatic stress disorder (38%), and thoughts of self-harm or suicide (15%).

 Although health care workers experience burnout at an alarming rate, they are less likely to receive psychiatric care because of barriers such as difficulty accessing care, “heroic” health care worker myths, and the stigma around mental health issues.

Self-care often is recommended for those experiencing burnout. Suggestions from members of the Pharmacist Moms Group for dealing with burnout include getting a massage, meditating, praying, or reading a book. Although these are ways to manage stress, they do not address the underlying situation, which is often related to the work environment. Advocating for self-care also puts the burden of reducing burden on employees rather than requiring anything of employers.

Here are 9 ways employers can help reduce stress in the pharmacy:

. Offer full or partial reimbursement for child care.

 Allow everyone’s input into scheduling, especially for parents with children.

 Explicit supervisor appreciation and encouragement go a long way.

 Chaos breeds more chaos. Organizing the pharmacy is extremely important. Sometimes just looking for a stapler can cause undue stress at work. This can easily be eliminated by staying organized.

 Pharmacy leaders must speak up to protect and support pharmacy workers.

 Provide food, such as pizza, for employees on Fridays, the night shift, and/or the weekends. Incentivize those shifts that are less desirable and it will be easier to find those who are willing to work.

 Reaching out to coworkers who may be experiencing stress
is critical.

 With gas prices higher than ever, compensating employees
for transportation to and from work is a wonderful way to make them feel appreciated.

 Provide access to evidence-based psychiatric treatment and help erase the stigma so that pharmacists and pharmacy technicians are not ashamed to seek help when they need it.

, is the chief academic officer at the Accreditation Council for Medical Affairs and the founder of Pharmacist Moms Group, the largest group of female pharmacists in the United States, with more than 45,000 members.

1. Hendrickson RC, Slevin RA, Hoerster KD, et al. The impact of the COVID-19 pandemic on mental health, occupational functioning, and professional retention among health care workers and first responders.

. 2022;37(2):397-408. doi:10.1007/s11606-021-07252-z

Here are 9 tips for employers to address employees’ feeling of detachment, exhaustion, and reduced accomplishment.

Mental Health

® Mental Health Resource Center is a comprehensive resource for clinical news and expert insights on conditions that affect mood, thinking, and behavior, including clinical depression, bipolar disorder, schizophrenia, anxiety, and post-traumatic stress disorder.

Women's Health

® Women's Health Resource Center is a comprehensive resource for clinical news and expert insights on issues related to health conditions that affect women, including gynecological health and maternal health.

Burnout: Self-care Is Not the Answer

Garden of Life has debuted raspberry-flavored Beets Gummies, which aim to promote energy and heart health. The gummies contain organic beet concentrate, apple juice and puree, raspberry puree, lemon juice concentrate, black currant, and tart cherry, as well as plant-based vitamin D3 and vitamin B12. Beets Gummies, according to the company website, contain nitrates to improve blood flow and heart health. The gummies also aid muscle growth and recovery and help build healthy blood cells. The organic and vegan gummies contain no genetically modified organisms.

O’Keeffe’s Healthy Feet Foot Mask intensively moisturizes extremely dry and rough feet with visible results after just 1 use. The foot mask is nongreasy and unscented and works in 15 minutes by creating a protective barrier on the skin’s surface to lock in moisture and keep skin hydrated, according to O’Keeffe’s website. In addition to the foot mask, the company also offers Healthy Feet Exfoliating and Healthy Feet Night Treatment.

Nervive Nerve Relief is designed to ease nerve aches, discomfort, and weakness linked to aging. The tablets taken once a day contain α-lipoic acid, which has been shown to help with nerve aches and discomfort, while B-complex vitamins build nerve insulation and enhance neurotransmissions, according to Nervive’s website. Relief starts in approximately 14 days. The company also says that after 4 weeks, the α-lipoic acid has been shown to reduce nerve discomfort by more than 50%.

Hydro Seal Non-Medicated Acne Blemish Patch

Band-Aid’s acne patches are designed to cover and protect blemishes and pimples. The hydrocolloid patch absorbs fluid from the blemish and forms a white bubble. The nonmedicated patch was tested by dermatologists and shown to provide comfortable wear and optimal healing. To use the patch, clean the skin and dry it before applying. Leave it on for 8 hours or overnight. The patches should not be used on severe or cystic acne, or on deep or infected acne wounds.

This month's product news features beet gummies, nerve relief, and acne blemish patches.

Vitamins and Supplements

® Vitamins and Supplements Resource Center is a comprehensive resource for clinical news and expert insights on issues related to OTC vitamin products and supplements.

OTC Product News: May 2022

approved in adults with type 2 diabetes mellitus-mediated chronic kidney disease

 (CKD) to reduce the risk of renal disease progression and cardiovascular events.

Approved by the FDA in 2021, finerenone is the only non-steroidal mineralocorticoid receptor antagonist for this purpose.

 Diabetes is the leading cause of CKD and renal failure in the United States, putting patients at risk for disturbances in fluid balance, electrolytes, and normal renal elimination.

In clinical trials, finerenone demonstrated efficacy related to renal and cardiovascular outcomes, regardless of patients’ history of atherosclerotic cardiovascular disease.

Finerenone selectively inhibits sodium reabsorption mediated by mineralocorticoid receptors.

 It also blocks mineralocorticoid receptor overexpression in kidney, heart, and blood vessel tissue; this mineralocorticoid receptor overexpression contributes to fibrosis and inflammation.

Of note, finerenone has no clinically relevant effects on androgen, progesterone, estrogen, and glucocorticoid receptors, unlike other currently available mineralocorticoid receptor antagonists.

Finerenone is indicated in patients with type 2 diabetes mellitus-mediated CKD to reduce the risk of:

It is available as both 10 mg and 20 mg oral tablets; the recommended starting dose is based on the patient’s eGFR as indicated in 

The target daily dose of finerenone is 20 mg, but clinicians should adjust doses based on both the patient’s current serum potassium concentration and finerenone dose.

 Finrenone’s package insert presents providers with guidance on this dose escalation.

Patients unable to swallow whole tablets may crush finerenone and mix it with water or soft foods, such as applesauce, immediately prior to oral administration.

The randomized, double-blind, placebo-controlled, multicenter phase 3 study FIDELIO-DKD evaluated finerenone’s efficacy and safety.

 A total of 4674 patients participated in the study, with 2833 patients randomized to the finerenone group and 2841 to the placebo group.

Researchers followed patients from the study for a median of 2.6 years.

 The mean age of participants was 66 years of age, 70% of patients were male, and mean eGFR at baseline was 44mL/min/1.73m.

Further, 99.8% of the patients at baseline were also on an ACE inhibitor or ARB.

Finerenone demonstrated a reduction in the incidence of a sustained decline in eGFR of at least 40%, and of cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure.

 In FIDELIO-DKD, 17.7% of patients in the finerenone group had at least 1 of these events, compared to 21.1% of patients in the placebo group.

The FDA granted finerenone both priority review and fast track designations for its application.

Contraindications, Warnings, and Precautions

Finerenone is primarily metabolized via CYP3A4; its concomitant use is contraindicated in patients on strong CYP3A4 inhibitors. Finererone is also contraindicated in patients with adrenal insufficiency.

Hyperkalemia is a risk associated with finerenone.Patients with elevated baseline potassium levels and decreasing renal function are at higher risk for developing hyperkalemia while taking finerenone.

Clinicians should monitor serum potassium and eGFR in all patients before initiating finerenone and periodically thereafter.

 Clinicians should also avoid initiating finerenone in patients with a serum potassium greater than 5 mEq/L.

In the FIDELIO-DKD clinical trial, hyperkalemia was the most frequently reported AE associated with finerenone (≥10%), followed by hypotension (4.8%) and hyponatremia (1.4%).

In patients with a serum potassium greater than 5.5 mEq/mL, clinicians should withhold finerenone.

 Patients previously on a 20 mg dose should restart finerenone at 10 mg daily when serum potassium is 5 mEq/mL or less.

For patients on a 10 mg dose who develop hyperkalemia, clinicians may also consider re-initiating at the same dose once serum potassium has normalized.

There are no data on the use of finerenone in pregnancy. Clinicians should advise women that breastfeeding is not recommended at the time of treatment with finerenone and for one day following treatment.

Lisa E Ruohoniemi, PharmD, is a clinical staff pharmacist at LewisGale Hospital- Montgomery in Blacksburg, VA.

FDA approves drug for chronic kidney disease. U.S. Food and Drug Administration. 

https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-drug-reduce-risk-serious-kidney-and-heart-complications-adults-chronic-kidney-disease

. Published July 9, 2021. Accessed March 7, 2022.

Kerendia. Prescribing Information. Bayer; 2021. Accessed March 7, 2022. 

https://labeling.bayerhealthcare.com/html/products/pi/Kerendia_PI.pdf

Filippatos G, Anker SD, Agarwal R, et al. Finerenone and Cardiovascular Outcomes in Patients With Chronic Kidney Disease and Type 2 Diabetes. 

. 2021;143(6):540-552. doi:10.1161/CIRCULATIONAHA.120.051898

Approved by the FDA in 2021, finerenone is the only non-steroidal mineralocorticoid receptor antagonist that reduces the risk of renal disease progression and cardiovascular events in adults with type 2 diabetes mellitus-mediated chronic kidney disease.

Diabetes

® Diabetes Resource Center is a comprehensive resource for clinical news and expert insights on the treatment of a group of chronic diseases that result in high blood glucose.

Chronic Kidney Disease

® Chronic Kidney Disease Resource Center is a comprehensive resource for clinical news and expert insights on issues related to long-term disease of the kidneys leading to renal failure.

Clinical Overview: Finerenone for Chronic Kidney Disease Associated With Type 2 Diabetes

 spoke with Amanda Ryan, PQA Director of Education, about why it was important for PQA to create a course focused on HIV.

 It was important for PQA to focus on HIV because, as I mentioned, there was not another course available that focus on quality measurement in HIV, but also, because of the pharmacist provided care aspects.

It's extremely important for pharmacists to be involved in helping care for people who have HIV, and also, we wanted to highlight other areas as well, including PrEP, which is pre-exposure prophylaxis. That's an increasing area of pharmacist provided care, and an increasing area where we want to think about quality measurement and ensuring that those patients receive high quality care.

PQA is uniquely situated to address those issues.

It's extremely important for pharmacists to be involved in helping care for people who have HIV.

HIV Course Focuses on Quality Measurement in the Pharmacy

 interviewed Murray Aitken, executive director of IQVIA Institute for Human Data Science, on the increase in spending on medicines in 2021 in the United States and implications for the US health care system.

 Hi, I’m Alana Hippensteele with Pharmacy Times. Joining me is Murray Aitken, executive director of IQVIA Institute for Human Data Science, who is here to discuss the increase in spending on medicines in 2021 in the United States.

So Murray, how much did spending on US medicines increase, and why might this increase have occurred?

 So yes, we did see spending on medicines increase in 2021. We measure that at about 12.1% increase in 2021. So that is the highest level we've seen for quite some time. That brings the total amount spent on medicines to over $400 billion. It's a lot of money, however you look at it.

The main reason, not surprisingly, is the amount that we spent on COVID-19 vaccines and therapeutics—that definitely took the growth rate up. In fact, if you back those products out, then the growth was 4.9%. So it made a big difference, and I'm not sure anyone's too surprised by that being the major factor.

 Right, absolutely. What did IQVIA data show regarding whether costs per prescription increased alongside this increase in overall spending in the US?

 So measuring the cost per prescription is not an easy thing to do because there are many different types of prescriptions and so on. One thing we do do, though, is look at the total market. By that, I mean branded drugs, generics, and biosimilars, and we mean retail drugs, as well as those used in clinics and pharmacies, and small molecules, as well as biologics. So taking all of those prescription medicines, we have a metric we call a defined daily dose, and so we convert the volumes into defined daily doses.

The total number, by the way, last year was about $194 billion defined daily doses, if we divide that into the total amount spent on medicines, and this, by the way, excludes vaccines, we end up with an average of $2.27 per defined daily dose in 2021. That is up 3 cents from the prior year of $2.24 in 2020. That's the average. In general, this is what we observe, which is, in terms of the overall market, we see relatively small levels of growth, that doesn't mean that there aren't pockets of higher growth going on. I think a lot of that is what people focus on and gets a lot of attention. But when you step back and look at the at the total, the level of growth is actually quite modest on a per prescription basis.

 Right, that's interesting. How about prescription drug use more broadly speaking, did prescription drug use for both chronic and acute care recover from the slowdown recorded in 2020? And if so, what are the implications of that?

 Yeah, so we've been tracking the volume of drugs since the beginning of the pandemic against that baseline of the 2 months prior to the onset of the pandemic, we see different patterns for chronic and acute medicines.

For the acute, we saw a very significant disruption during the early part of the pandemic. They have continued to be at below average levels. Part of this is a consequence of the impact of social distancing and stay at home orders. Fewer children were in school, meaning fewer ear infections and so on. We also had a very light flu season last year. So all of these factors bring down the level of acute medicines being prescribed, and that decline has moderated since the beginning of the pandemic, but it's still below pre pandemic levels.

For chronic medicines, first off, we saw significant stockpiling at the very beginning of the pandemic. Since then we've actually seen the level of chronic prescriptions that are essentially refills, so continuing prescriptions, those have stayed very stable right at the level they were pre-pandemic. However, for chronic new to brand prescriptions, so whereas someone is going to see their doctor and beginning a new prescription, these have always been below the pre-pandemic baseline level. Even now, they're still sort of 2% to 5% below that baseline.

So this is also a reflection that we've had people not go to their doctors for their annual checkups and visits where oftentimes new brand prescriptions are prescribed. We continue to have this backlog of patients if you like. So this is something that is a concern. Of course, if there isn't a new prescription started then there's no refill either. So we expect to see that these chronic prescription volumes will remain below the pre-pandemic level for some time.

Murray Aitken, executive director of IQVIA Institute for Human Data Science, discusses the implications  of the increase in spending on medicines in the United States in 2021.

Coronavirus

® Coronavirus Disease Resource Center is a comprehensive resource for clinical news and expert insights on COVID-19, an infectious disease caused by the SARS-CoV-2 virus, including vaccine information and treatments for the disease.

Expert: US Spending on Medicines in 2021 Was Higher Than in Recent History

Fourth-year pharmacy students are entering their Advanced Pharmacy Practice Experiences (APPEs), marking the end of an era and the start of a new adventure.

Some students may make a smooth transition, but others may feel anxious and unsure about what to expect. This was my experience, and I am here to tell you it is OK.

It is normal to feel anxious or ill-prepared. After all, APPE students are expected to perform at the highest level of their knowledge. Be that as it may, it is important to be patient. We are only human, and though we are expected to be knowledgeable, the truth is that we do not know everything. Life itself is a learning curve, and everyone has to start somewhere.

To gain the most from APPE rotations, pharmacy students must be eager to learn and inquisitive. Ask thought-provoking questions and always ask why to dig deeper and read more. It is easy to answer the “what,” such as what are the first-line medications used to treat diabetes, hypertension, heart failure. But why are they the first-line agents? What evidence supports their use? Some students may think they do not know how to think critically, but this skill starts by asking “why.”

Additionally, pharmacy students must ask for feedback. Asking for feedback does not necessarily mean asking what was done right or wrong in a particular situation, but it can mean asking for a deeper exploration. Rather than asking “Is there anything that I can improve on?” ask open-ended questions, such as “What aspects of communication, leadership, patient care, and inter-professionalism can I improve upon?” Alternatively, “How do you feel about my style of communication? My leadership skills? How I deal with patients?” Whatever the response, use it as a strategy for growth. For students with an inquisitive mindset, asking for feedback should not feel painful.

When trying to improve skills, pharmacy students should not be afraid to ask other students for feedback, especially those who excel in these specific areas. Pharmacy students should recognize their strengths and use them to their advantage, while remaining mindful of their weaknesses and working to improve them. They should be honest with themselves, and let preceptors know what those weaknesses are and ask how best to improve them.

Finally, preceptors show up every day, hoping to impart knowledge. Pharmacy students should show them their appreciation and let them know that their work does not go unnoticed. Positive reinforcement is a 2-way street. It is not an easy task to precept students, and it takes strength to remain committed, so pharmacy students should salute the ones who do.

Although APPE rotations can be challenging and stressful, asking questions and finding enjoyment in the challenge is vital to get the most out of these experiences. Pharmacy students should build partnerships with preceptors and fellow students and learn to recognize their strengths and weaknesses to become the best possible pharmacists.

To maximize this challenging experience, pharmacy students should be eager to learn and inquisitive.

Student

® Student Clinical Role section is a comprehensive resource for clinical news and expert insights on issues pertaining to pharmacy school students and their various career options.

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