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Several pharmaceutical market trends are likely to affect pharmacists’ practice this year...The Pharmacy Forecast 2016-2020 from the American Society of Health-System Pharmacists Foundation analyzed pharmacy trends and described strategies for health-system pharmacists to keep pace with the evolving scope of their practice...Pharmacists and health systems must recognize, plan for, and appropriately react to dynamic trends in the pharmaceutical marketplace to ensure that they are positioned to continue providing the best patient care...Here are 4 pharmaceutical market trends to watch in the year ahead:

1. Generic Drug Pricing
2. Enforced Product Tracing
3. Specialty Drug Spending
4. Limited Drug Distribution Channels

As population health management becomes increasingly critical, health-system pharmacists should reacquaint themselves with the factors driving patient outcomes...American Society of Health-System Pharmacists Foundation identifies population health management as one of the key trends that will define the scope of health-system pharmacy practice over the next 4 years...Optimizing population health requires health systems to recognize that their role has moved beyond providing immediate sickness care and now involves evaluating many aspects of a patient’s lifestyle in order to be proactive about preventing the need for hospital admissions and readmissions...researchers at the University of Wisconsin Population Health Institute studied various factors driving health outcomes...following 3 factors were areas where pharmacist intervention can play a larger role in enhancing population health care:

• Modifiable Patient Behaviors
• Medication Management
• Social and Economic Environments

All MTM (medication therapy management) services may be billed for, but the question remains: which insurance companies will reimburse them? Many studies have validated the value of the pharmacist in providing MTM services solely as a cost-avoidance model for any specific medical group. Ideally, MTM services would be billed and reimbursed while cost-avoidance would be documented through an increasingly positive outcome of care for these specific patients...MTM services may be focused on specific situations such as a targeted medication review or discharge education, or they may be provided as complete comprehensive medication reviews...The following are general descriptions of the different forms of MTM services:

• Comprehensive Medication Review
• Target Medication Review
• Bedside MTM
• As Time Permits
• Inpatient MTM Program
• Outpatient MTM Program
• Complete MTM Program
• Billing for MTM Services
• MTM Implementation
• Conclusion

In time for the quit smoking New Year resolutions that are anticipated at the end of this month, the International Pharmaceutical Federation has outlined the wide variety of different ways in which pharmacists can reduce the use of tobacco through a new publication. The briefing document, "Establishing tobacco-free communities: A practical guide for pharmacists", gives a number of examples from around the world, showcasing pharmacists’ value in performing health promotion, triage and referral as well as other interventions.

Although using a patch formulation of fentanyl can have some advantages, here are 5 common problems I've encountered with it in my pharmacy practice:

1. Fentanyl patches are extremely potent
2. Lost or missing fentanyl patches should scare you
3. Fentanyl patches are meant for chronic pain
4. Fentanyl patches can cause delayed withdrawal symptoms
5. Fentanyl patches get diverted

Alexander Kantorovich, PharmD, BCPS, clinical assistant professor of pharmacy practice at Chicago State University College of Pharmacy, discusses how closer integration of pharmacists into care teams improves outcomes for patients taking new oral anticoagulants.

Aaron Steffenhagen, PharmD, BCPS, clinical pharmacy manager at University of Wisconsin Hospital and Clinics, discusses some ways pharmacists have helped in cardiopulmonary resuscitation efforts.

Medicines information contained in a third of hospital discharge letters for paediatric patients contained “discrepancies” that were picked up by a pharmacist, according to research...the study supports the role of pharmacists to routinely check discharge medication letters and carry out medicines reconciliation when children are sent home from hospital...Our study suggests that pharmacists’ screening and review of discharge medication letters prevents one in five potentially harmful discrepancies from leaving the hospital...researchers say their prospective study is the first to examine the accuracy of discharge letters in paediatric patients. They looked at electronically generated medication discharge orders written by hospital doctors that were then checked by a pharmacist... pharmacists, and preferably paediatric-trained pharmacists for paediatric patients, should routinely check discharge orders. “We pick up a lot of mistakes and clarify misleading instructions by doing so,”...“It is nice to have this backed up by evidence.”

Alongside the growing prevalence of chronic pain and prescription opioid use, drug-related overdose continues to claim the lives of 17,000 Americans each year...Deaths from unintentional opioid overdose have increased 56% since 2010. In 2013, 83% of the opioid overdoses were unintentional...In 2010, there were approximately 136,000 emergency room visits related to opioid-induced respiratory depression and overdose. Needless to say, opioid overdoses are...drastically increasing health care costs...When naloxone is administered by first responders outside an institutional setting, it can improve outcomes for emergency opioid reversal prior to a patient reaching the emergency department. There are currently 2 FDA-approved naloxone formulations for take-home use: the auto-injector...and the new intranasal formulation...

• Who Should Receive Take-Home Naloxone?
• The Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD)
• Risk Factors Associated with OSORD (opioid-induced respiratory depression)
• How Can I Use RIOSORD in a Community Pharmacy?
• Risk Mitigation and Patient Education
• Conclusion

With the availability of naloxone for take-home use, no one should lament over the loss of a loved one because a life-saving medication was not easily accessible...We can’t agree that naloxone availability will end opioid overdose deaths, but it certainly is our professional responsibility to ensure that we’ve taken every step to reduce risks...Pharmacists, physicians, and student clinicians have an excellent opportunity to mitigate opioid overdose risks by employing the validated RIOSORD tool. RIOSORD can aid opioid prescribers in identifying at risk patients, and it can also help encourage a candid dialogue among pharmacists, patients, and caregivers to reduce patient harm.

Health-system pharmacists will inevitably face growing ethical challenges as their roles in patient care continue to evolve...ethical dilemmas embedded in health-system pharmacists’ everyday practice include competing interests, limited resources due to drug shortages, and an evolving health care delivery system that has shifted their role from dispensing medications to actively participating in direct patient care...One of the hot-button ethics issues in pharmacy currently is the trend of skyrocketing prescription costs and the lack of transparency in drug pricing decisions. Extremely high prices and lagging reimbursement may preclude health-systems from providing necessary medications to all patients who would otherwise benefit..."Patient welfare is at risk when the ethical perspective in health care is smothered by business and financial perspectives,"..."Patient well-being often hinges on the ability of health professionals to heed the ethical precepts of their calling."...Pharmacists are currently vying to gain support for an expanded role in patient care in the form of provider status, which will likely be more easily garnered if they are perceived as being on the side of patient care rather than the side of business interests.