Publications by authors named "John S Clark"

Article Synopsis
  • The report analyzes historical pharmaceutical spending in the U.S. and predicts factors influencing future expenditures, especially in nonfederal hospitals and clinics, for the year 2024.
  • In 2023, total drug spending reached $722.5 billion, a 13.6% increase from the previous year, driven by heightened utilization, new drug approvals, and moderate price increases.
  • For 2024, overall drug spending is projected to rise by 10.0% to 12.0%, with clinics and hospitals expecting an increase of 11.0% to 13.0%, highlighting the ongoing impact of specialty and cancer drugs on spending.
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In response to the opioid epidemic, the Centers for Disease Control and Prevention released best practice recommendations for prescribing, yet adoption of these guidelines has been fragmented and frequently met with uncertainty by both patients and providers. This study aims to describe the development and implementation of a comprehensive approach to improving opioid stewardship in a large network of primary care providers. The authors developed a 3-tier approach to opioid management: (1) establishment and implementation of best practices for prescribing opioids, (2) development of a weaning process to decrease opioid doses when the risk outweighs benefits, and (3) support for patients when opioid use disorders were identified.

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Purpose: This publication outlines the development and implementation of a leadership enhancement program for pharmacy technician supervisors at University of Michigan Health (UMH). The program aims to equip these supervisors with the skills and knowledge necessary to excel as leaders in the pharmacy field, addressing the pressing need for strong leaders in healthcare.

Summary: UMH recognized the need to cultivate effective leaders within its pharmacy department due to the impending shortage of pharmacy leaders and the rising demand for technicians and future pharmacists.

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Article Synopsis
  • The report analyzes historical pharmaceutical spending trends and predicts future drug expenditures in the US, particularly in nonfederal hospitals and clinics for 2023.
  • It reviews factors affecting drug spending such as new drug approvals, patent expirations, and policy changes, concluding that specialty and cancer medications will significantly impact future costs.
  • In 2022, drug spending rose by 9.4% to $633.5 billion, with a forecasted 6.0% increase in overall spending for 2023.
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Introduction: The demands posed during the coronavirus disease 2019 (COVID-19) pandemic have led to greater stress and frustration, which in turn can fuel exhaustion, cynicism, secondary traumatic stress (STS), and burnout. More evidence is needed regarding the prevalence of burnout and STS throughout the pandemic.

Objectives: The aim of this study was to describe the changing pattern of the prevalence of burnout and STS in health-system pharmacists throughout the pandemic (early to 20 months into the pandemic).

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Article Synopsis
  • The report analyzes historical trends in pharmaceutical spending in the U.S. and predicts factors impacting future costs, particularly in nonfederal hospitals and clinics for 2022.
  • In 2021, drug spending increased by 7.7% to total $576.9 billion, driven by higher utilization, prices, and new drug approvals, with adalimumab being the top costing drug.
  • For 2022, overall drug spending is projected to grow by 4.0% to 6.0%, with clinics and hospitals expecting increases of 7.0% to 9.0% and 3.0% to 5.0%, respectively.
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Article Synopsis
  • The report analyzed historical patterns of pharmaceutical spending in the U.S. and aimed to predict growth for 2021, focusing on nonfederal hospitals and clinics.
  • Drug expenditures grew by 4.9% in 2020, mainly due to increased utilization and new drugs, with the top drugs being adalimumab, apixaban, and insulin glargine.
  • For 2021, an overall increase in prescription drug spending of 4% to 6% is expected, with clinics forecasting a 7% increase, driven by new product approvals and ongoing effects of the COVID-19 pandemic.
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Purpose: To describe the prevalence of burnout and secondary traumatic stress (STS) in health-system pharmacists during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: A cross-sectional, professional pharmacy organization listserver-based online survey of a target group of health-system pharmacists across the United States was conducted. The survey was sent out through professional organization listservers and was anonymous and voluntary.

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Objective: To compare health-system pharmacy leadership pathways and opinions in the last decade.

Methods: A 33 question survey was recreated from the 2009 survey of health-system pharmacy leadership pathways and reviewed and modified by the original creators. In November 2019, investigators sent two invites to complete a Qualtrics survey to individuals listed on the ASHP Connect Pharmacy Practice Leaders listserver.

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Multiple groups have described strategies for clinical implementation of pharmacogenetics (PGx) that often include internal laboratory tests that are specifically developed for their implementation needs. However, many institutions are not able to follow this practice and instead must utilize external laboratories to obtain PGx testing results. As each external laboratory might have different ordering and reporting workflows, consistent reporting and storing of PGx results within the medical record can be a challenge.

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Hierarchical Condition Categories (HCCs) are a common risk adjustment tool that may support alignment of care management resources with the clinical needs of a population. The authors examined the association between HCC scores and physician-determined clinical risk (CR) scores, annual charges, and utilization of medical care. CR score was defined as the anticipated risk for "ED or a hospital admission" within the following year.

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Purpose: To report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2020 in the United States, with a focus on the nonfederal hospital and clinic sectors.

Methods: Historical patterns were assessed by examining data on drug purchases from manufacturers using the IQVIA National Sales Perspectives database. Factors that may influence drug spending in hospitals and clinics in 2020 were reviewed, including new drug approvals, patent expirations, and potential new policies or legislation.

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Purpose: Highly publicized safety issues arising from poor sterile compounding practices in facilities around the United States have garnered substantial attention in recent years. This attention has led to increased scrutiny of health systems by regulatory bodies, new regulatory requirements, and changes to existing regulations or their interpretation. Health systems are often resource constrained, and the added work resulting from this scrutiny challenges pharmacy departments in meeting regulatory requirements and United States Pharmacopeia chapter 797 standards for sterile compounding.

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The Patient-Centered Medical Home (PCMH) has become a widely implemented model to transform the delivery of care, but little evidence exists regarding the model's impact on providers, nurses, and staff. This study examined the impact of the PCMH model on (1) provider and staff satisfaction, (2) work-life balance, (3) teamwork, (4) professional experience, (5) patient care factors, and (6) quality outcomes. The authors confidentially surveyed physicians, advanced practice providers (APPs), nurses, care managers, and office staff in 2011 prior to implementation of the PCMH model and in 2016 after implementation at 34 primary care offices providing care to 171,045 patients.

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Purpose: Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2019 in nonfederal hospitals, clinics, and overall (all sectors).

Methods: Drug expenditure data through calendar year 2018 were obtained from the IQVIA National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2019 were also reviewed.

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Purpose: Results of a study to determine time and cost requirements for final preparation of continuous renal replacement therapy (CRRT) products are reported.

Methods: A 3-phase observational study was conducted at a tertiary care university hospital to evaluate costs associated with manual addition of phosphate and/or potassium to 3 commercial 5-L CRRT products. In the first phase of the study, pharmacy workflow processes for solution preparation were established; in the second phase, pharmacist and pharmacy technician time spent in the CRRT workflow and all materials used were observed and recorded.

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Objective: To assess the difference in pharmacy error detection rates when using a manual process compared to an intravenous workflow management system for the preparation of parenteral medications.

Methods: Baseline error data were collected by staff using a standard form over a four-day time period before intravenous workflow management system implementation and compared to 48 weeks of electronically collected data following implementation. The chi-square test was used for statistical comparisons.

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Purpose: An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI).

Methods: The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique.

Results: Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member.

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