The annual survey hit on key health-system pharmacy insights related to formulary management, pharmacogenomics, and opioid stewardship, among others.
The American Society of Health-System Pharmacists (ASHP) announced the results of its annual survey of pharmacy directors from almost 5000 hospitals across the country, which delivered valuable insights on hospital and health system pharmacy practice.
The 2019 ASHP National Survey, published in the American Journal of Health-System Pharmacy (AJHP), gauged prescribing and transcribing strategies used by hospital pharmacy and therapeutics (P&T) committees, with the most common tools including therapeutic interchange, evidence-based clinical practice guidelines, opioid stewardship, and comparing the efficacy of products when making formulary decisions. The survey also pointed to additional trends in areas of staffing and the use of mobile technology.
Lead author Craig A. Pederson of Virginia Mason Medical Center noted that the findings are not surprising, as these strategies have been proven to be effective. Of note, the results determined an increase in the use of therapeutic interchange since 2016.
Other noteworthy trends on the basis of formulary management from the survey:
“Seventy-two percent of hospitals use protocols that transfer authority for product selection and dosing from prescribers to pharmacy as a strategy by P&T, suggesting that pharmacists are increasingly recognized as effective stewards of the formulary system, and at implementing formulary standards,” Pedersen said. “This is significantly less than 77% of hospitals in 2016.”
Related to pharmacogenomics, a mere 5.4% of hospitals who participated in the survey reported their recommendations for or scheduling of pharmacogenomics testing for determining drug and dosage; 90% indicated that their pharmacists experience limitations in dispensing products for pharmacogenomics drugs therapy management.
But although the survey showed limited pharmacy involvement in this area of drug management, Pederson remains hopeful that the prevalence of pharmacogenomics will only improve from here.
“There are a lot of drug products with pharmacogenomic markers,” Pederson said. “So where are pharmacists in pharmacogenomics? At this point, pharmacists play a very limited role. Some might be very disappointed in that — I think there are a lot of people that are highly invested in this. But my point is that pharmacogenomics has not yet become the pharmacokinetic monitoring of pharmacy. That’s not to say that I don’t think it will.”
On the other hand, more positive trends from ASHP’s survey were found in opioid stewardship, as 47% of hospitals had active opioid stewardship programs, compared with 41% in 2018, and 65% indicated that their pharmacists function as leaders for accountability concerning the hospital’s opioid stewardship programs.
Philip J. Schneider, co-author and professor in the College of Pharmacy at The Ohio State University, lauded these trends showing increased pharmacist participation. “The good news is that if a hospital has an opioid stewardship program, which nearly half do, pharmacists are almost always involved,” he said.
Other areas of growth in this sector included the following:
Results from the survey also included data on hospital staffing of pharmacists, as the number of full-time pharmacist positions have grown since 2016, with a mean of 19.2 positions for each 100 occupied beds. Pharmacists also showed a vacancy rate of less than 3%; pharmacy technicians had a vacancy rate of 6.5%. Despite challenges in vacancy rates for technicians, human resource commitments to support new services are increasing, and staff credentialing continues to expand for pharmacists and technicians, the authors wrote.
Encouraging results also took form in the survey’s data concerning mobile technology. The majority of pharmacists are now using smartphones, tablets, or laptops to supplement and facilitate patient care services following the nearly universal adoption of the universal electronic health records.
“Pharmacists continue to assume greater responsibility for writing medication orders, dosing, ordering laboratory tests, and monitoring outcomes,” the authors of the survey reported. “Health-system pharmacist are taking a leading role in addressing the opioid crisis, advancing safety in compounded sterile preparations through adoption of intravenous workflow technologies, and optimizing EHR applications to leverage clinical decision support tools to improve the safe prescribing and use of medications.”
The survey was conducted prior to the COVID-19 pandemic.