Halfway through the 2010 decade, pharmacists find plenty of medication challenges to address but lots of obstacles too. Here’s how 2014 treated them and their patients.
1. Infectious Diseases Cause Sickness, Deaths: With severe influenza seasons as bookends, 2014 had plenty of pestilence. Media coverage fanned hysteria in the United States over a handful of patients with Ebola, while the West Africa case count and deaths rose to 20,081 and 7,842 at year’s end. Enterovirus cases surged in the fall, and a CDC analysis found that roughly half of the H3N2 viruses were drift variants, making the most recent influenza vaccine less effective against this common influenza strain.
2. Antibiotic Stewardship: Overuse of anti-infective agents persisted, leading to resistance despite pharmacists’ collaborative efforts in antibiotic stewardship programs. The possibility of a cure in those with hepatitis C virus was threatened by a huge gap in costs of the new HCV drugs and the need for more clinical testing in difficult-to-treat patients.
3. Pharmacists Seek Medicare Recognition: The big news in the profession was introduction of a bill calling for addition of pharmacists to the Medicare Part B provider list for services in medically underserved communities. A strong coalition formed to spearhead this effort, and op-ed pieces published in lay media called for support of pharmacists as “capable providers in an incapable system.” When Congress reconvenes in January, a reintroduced bill will find a pharmacist in the House and GOP control of the Senate, thanks to Republicans’ midyear election sweep.
4. FDA Has Banner Year of Approvals: With 41 approvals of new molecular entities, FDA topped the 21st century records of 39 new drugs in 2012 and 36 in 2004. Dalbavancin (Dalvance—Durata Therapeutics) became the first agent approved as a Qualified Infectious Disease Product, and a report looked at reasons for denials and delays by the agency.
5. Pharmacy Compounding Sequelae Continue: The legal system continued its response to the 2012 compounding-driven fungal meningitis epidemic, with eight pharmacists charged criminally. The new compounding law was implemented.
6. Advances in Clinical Medicine: Plenty of new guidelines were released even as controversy continued over the ones for lipids and hypertension. Early goal-directed sepsis management promised to usher in a new era. Polypills for cardiovascular conditions and HIV offered better adherence, while polypharmacy presented problems.
7. Digital Medicine & Genomic Biomarkers: Electronic health records were implemented as incentives kicked in. Health information exchanges expanded, and electronic medication packaging could assist with adherence. Pharmacogenomics continued to be controversial, with some saying FDA labeling for related biomarkers was premature, even as studies pointed to ways such information could greatly enhance personalized drug therapy.
8. Placing the Patient—Warts & All—at the Center of Care: Many studies examined ways of empowering patients and placing them at the center of patient care, even as evidence showed that their lifestyle choices presented problems that medications could only paper over.
9. Weed and Cigs and Oxy, Oh My: While CVS pulled tobacco products, patients’ habits were particularly problematic in the abuse of tobacco and e-cigarettes, marijuana, opioid analgesics (which led to hydrocodone rescheduling and other efforts to make them harder to abuse), and new drugs of abuse.
10. Pharmacists Moving on Up: Pharmacists’ direct patient care efforts were noteworthy, including outcomes in hospitals with cardiovascular-credentialed pharmacists, Medicare Annual Wellness Visits, and Project IMPACT Diabetes. CDC officials recognized the expanding roles of pharmacists, and the CMS Innovation Center granted $15 million for a North Carolina study of community pharmacy’s reduction of health costs.