Section 1
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Questions to ask while evaluating reply
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Last updated
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Date created
Mar 1, 2020
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Section 1
(50 cards)
Questions to ask while evaluating reply
1. does the response answer the question? 2. is the info clinically applicable? 3. is response organized? 4. follow-up
Role of P and T committee?
Develop: Formulary, policies, MUE, ADR, Med Safety
Why is it critical to follow the systematic steps in a DI consult?
legal implications
Which steps do you follow during a DI consult?
systematic process
A BLANK is a summary of evidence, requiring you to interpret the information and synthesize a response
literature review
What is the secondary audience?
other physicians, caregiver, nutrition/PT, pt (if access to medical records)
What guidelines does research follow?
clinical practice guidelines
What are the 4 R's to the simplified process?
receive, research, respond, record
When answering a question, what should you always anticipate?
secondary questions
How should a DI consult be edited?
for clarity, efficiency, directness, avoid excessive pronoun use
What does research entail?
develop strategy and conduct systematic search
How to formulate a response?
intro with background info, body with presentation of data, conclusion with recommendation, references
The intro contains background info, which entails...
PMH, SH, FH, physical/objective findings
How to systematic search with DI resources?
tertiary --> secondary --> primary --> internet
Describe secondary resources
ID pertinent review articles, ID primary literature with comparing listings of abstracts/full text
How to analyze?
critical assessment, objective review/critique, positive and negative findings
What is a DI consult?
when a provider consults the pharmacist (drug specialist) with regards to a medical question
Why is background info important?
communicate with requestor to learn question context, pertinent pt data, time need if requestor
What does the conclusion entail?
answer the question, no new info, references
How many steps to the modified approach?
7 steps
What happens when you fail to obtain the ultimate question?
correct answer to an incorrect question
What are ad hoc committees?
subcommittee (nutrition, ID, special working groups)
How to keep track of data?
use collection sheet/program
Describe primary resources
original data, needs critique, most current evidence
Describe tertiary resources
can help get the researcher up to speed, review disease states, may completely answer question with sufficient evidence summary
Why does categorization matter?
help determine rational search strategy
Why is determining the ultimate question important?
to ensure the pharmacist is giving the correct answer with appropriate background info
What is a formulary committee?
a subcomittee of P and T
When do you do a DI consult?
questions that are substantially involved
Why is a formulaic approach not useful?
no systematic approach applies to all situations
How to reference?
sequential numbering in text, superscripted, end notes
Parts of a DI consult
1. intro/purpose 2. assessment 3. lit review 4. conclusion
Disadvantages of tertiary resources?
may be outdated, inconsistent, biased, incomplete
What is the purpose of a DI consult?
To provide a solution, relate findings, voice concern, or convince audience of a treatment path
Disadvantage of primary resource?
time consuming to evaluate
What is a P and T committee?
Pharmacy and Therapeutics Committee
How many steps to the systematic approach?
5 steps
What does record entail?
verify response appropriateness (was recommendation accepted/questions or follow-up), systematic process, provide updates if new info becomes available
What to do after response?
evaluate reply
What does background information entail?
pt-specific questions, treatment's already tried, resources already consulted
What is the primary audience?
person who asks the question
Which methods are used to assess quality of guidelines?
GRADE and consensus based
What information does receive entail?
demographics, background info, ultimate question
What does the membership committee entail?
voting and non-voting, chair, secretary (usually pharmacist)
What does a P and T committee do?
oversees all aspects of drug therapy; safety, efficacy, cost effectiveness
Disadvantages of secondary resources?
need to know how to use it
What is the best source for a foreign drug?
Martindale or Index Nominum
What does "respond" entail?
analysis of evidence and synthesis
GRADE
Grading of Recommendations, Assessment, Development and Evaluations
What does the assessment entail?
evaluation of situation/pt by interview or reviewing medical records and lab data, descending order of importance, factual
Section 2
(50 cards)
Which of the following attributes specific to a drug would be an appropriate rationale for conducting an MUE?
significant side effect profile, narrow therapeutic index window, new drug
What does MUE analysis entail?
multidisciplinary group should oversee or review findings, compare actual performance with expected performance
What is a concurrent claim?
ongoing, monitoring of drug therapy during the course of treatment
Why is prior authorization used?
optimize pt outcomes, safety and efficacy, reduce waste, need approval from payer to dispense/administer, ensure med is medically necessary
T/F: the monograph is not the package insert
true
What is an open formulary?
All drugs are available on the formulary
Goal of DUR?
identify and decrease fraud, abuse, overuse, inappropriate/medically unnecessary care
What is a formulary?
Continually revised list of medications that are readily available for use within an institution or 3rd party that reflects the current clinical judgment of the medical staff or payer
Minimum requirements for monograph?
indication, effectiveness, risk, cost
Impact of benefit management?
ensures pt receives medication and benefits from it
How to choose a drug?
high volume, high risk, high alert (narrow index), new formulary conditions, new protocol policy/procedure, problem prone, high cost?
What is a retrospective claim?
review of drug therapy after the patient has received the medication
Function of TJC?
safe and effective medication management system, CQI required
What is the treatment algorithm/step therapy based off of?
national guidelines for agent safety and efficacy
Why do we use drug monographs/class reviews?
present information in an unbiased manner
Is there a singular definition for specialty meds?
no
What is a positive formulary?
Add drugs once they are approved
there are 30 cases, how many should you review?
all of them
What is a MUE?
medication use evaluation
BLANK provide support for P and T committees
Drug information centers
What is a TJC?
The Joint Commission
What does MUE result entail?
interventions, follow-up, repeat performance improvement process
Why perform MUE?
- evaluate effectiveness - improve patient safety - standardize therapy to decrease variation - optimize drug therapy - meet quality or regulatory standards - minimize costs
Impact of cost savings on health system?
less tax money on meds for government business, savings for ultimate payer/pts in terms of premium $
there are 30-600 cases, how many should you review?
at least 30
What does MUE Plan entail?
develop methodology based on performance improvement plan, standards of performance, evaluation time frame, pt selection/sampling, data collection, create data collection tool
What is a negative formulary?
Remove drugs that are deemed unsafe or inferior
Is a package insert a primary source?
yes, can reference
Interventions/corrective actions entail...
education, restriction, process change
What does utilization management entail?
1. prior authorization 2. step therapy "fail first" 3. quantity limits 4. generic substitution
What is a DUR?
drug utilization review
Are dietary supplements proven for safety and efficacy?
no
What does a monograph entail?
clinical indications, Pharmacology/MOA, kinetics, efficacy assessment, toxicity assessment, drug interactions, contraindications, special populations, dosage/admin, product availability, cost comparison, references
there are >600 cases, how many should you review?
5%
What are the 9 concepts for effective prior authorization programs?
1. pt safety and appropriate medication use 2. clinical decision making 3. evidence-based review criteria 4. automated decision support 5. transparency and advanced notice 6. emergency address 7. provider collaboration 8. need for timelines and avoiding disruptions in therapy 9. cost effectiveness and value
How to perform MUE?
Collaboration, responsibility, must adapt to practice setting w/ practice use guidelines
What is a closed formulary?
Has a specific list of drugs on the forumlary
Goal of MUE?
optimize pt outcomes (target drug program, drug use program)
How does P and T committee agenda get determined?
1. request for formulary change 2. change in 1 class 3. new entrant to market
Purpose of MUE?
evaluate medication use processes or tx response
A formulary includes Nexium, this class (GERD) includes several more drugs not on the formulary - what type is it?
closed
Can a pt appeal prior authorization denials?
yes, multiple times
Function of DRR?
drug review regimens in nursing facilities, required by HCFA and implemented in 1974 through medicare and medicaid
What kinds of meds aren't considered medically necessary?
cosmetic indication, sildenafil
BLANK is an assortment of strategies/tools used by health plans and PBMs to administer the pharmaceutical benefit
utilization management
What is a DRR?
drug regimen review
What is a prospective claim?
evaluation of a patient's drug therapy before medication is dispensed
What goes into prior authorization criteria?
indication, prescription by physician, initial criteria, continuing criteria, duration of approval, quantity limits
Role of pharmacists on P and T committee?
prepare agenda, prepare materials (monograph), present materials, answer questions, follow-up actions
Common definition for specialty meds
used in rare/orphan conditions, high touch agents (TPN), medicare >670/month
Section 3
(38 cards)