By Carson Goff
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December 3, 2020

On November 13th, 1789, Ben Franklin, wrote a letter to Jean-Baptiste Leroy saying, “Our new Constitution is now established, and has an appearance that promises permanency; but in this world, nothing can be said to be certain, except death and taxes.” Ben Franklin’s words certainly still hold true today. However, in this article, I plan to draw attention to a crisis that requires major action and change to prevent premature death, and, unfortunately, I will also draw the necessary correlation to the almighty dollar and tax revenue.

While preparing to write this article it has been difficult to find words or examples to put the year 2020 into perspective while bringing up yet another heart-wrenching topic. There is no doubt that this year will always be remembered for a time of uncertainty. This moment in our country’s history will leave an indelible mark on all generations, hopefully, many positive changes will take effect but there is no doubt some will have negative memories. Specifically, the pandemic has been devastating on so many levels, and racial injustice (and the following riots) have been tragic. These events have shaken up the United States and have forced individuals to ask themselves very difficult questions about their personal health and safety and the health and safety of their loved ones. What’s worse? We have other life-altering healthcare crises that continue to persist. The opioid crisis was already serious, but it has intensified during the pandemic.

Recently, my colleague, Lauren VenDenBoom, brought it to my attention that Monday, August 31st was International Overdose Awareness day. She wrote a blog post articulating the harsh truth that 128 people die every day from an opioid overdose!! She cited many other staggering and sobering facts here: https://www.hc1.com/blog/lets-not-forget-the-other-epidemic-opioid-overdose/.

My CEO, Brad Bostic, also sent me an article on Sunday evening that argues how the opioid crisis is “a unique product” of US health care. In the article written by Alexis Keenan and Adriana Belmonte of Yahoo Finance, they reported that “U.S. states are claiming that opioid manufacturers, distributors, and others who fueled the country’s decades-long opioid crisis will cost the economy at least $2.15 trillion by the year 2040. Between 2007 and 2019, the states estimated that their systems took a $630 billion hit. Anticipated costs of $1.53 trillion from 2020 to 2040 are estimated to run up the rest of the tab. The figure was reported in a filing made public Monday in the Southern District of New York in the bankruptcy case for OxyContin maker Purdue Pharmaceutical.” You can access the entire article here: https://news.yahoo.com/opioid-crisis-health-care-system-165837992.html

opioid crisis

+ The picture above is of Cataldo Ambulance medics and other first responders reviving a 32-year-old man who was found unresponsive and not breathing after an opioid overdose on a sidewalk in Everett, Massachusetts. (REUTERS/Brian Snyder)

$2.15 trillion dollars is as shocking of a number as I can imagine being linked to the opioid crisis. Do I even have to start contextualizing how big a number that is when it starts with the letter “t”? I have spent my career in some sort of sales capacity which typically requires me to create cost-benefit analysis or return on investment calculations. Those analyses have provided justification for the various organizations I engage that are evaluating an investment in software solutions. It made me think, do we really need to cost-justify lives being lost? I hope not but change is often slow unless we create the necessary urgency to gain attention and priority. Thus, the cost of the loss of lives is unfathomable when you look at it from a tax revenue perspective, but much more importantly, the loss of life means that a mom or dad, son or daughter, brother or sister are no longer with us because of an opioid overdose. Is there anything more precious or urgent than the value of a life?

The best news is that these premature deaths are preventable! Many new innovations have spawned to put real-time insights into the hands of prescribing providers that detail what is in the patient’s body (lab tests) and what should be in their body (prescription drug monitoring program). Timely insights and #clinicaldecisionsupport will help providers make better opioid prescribing decisions. That gives me optimism that as we continue through this tumultuous year, we can make a difference by delivering the appropriate interventions to improve opioid prescribing while better informing clinical practice. These innovations will identify and protect at-risk patients and can make a dramatic and positive difference in outcomes!

I have asked a number of questions in this article and I will reiterate two important questions we need an answer to…. how many premature deaths, or in the more unfortunate view, how much tax revenue has to be lost for our federal and state legislators to start enforcing more stringent policies and procedures when it comes to the distribution of opioids? Ben Franklin may have been right about death and taxes, but people pay taxes and taxes help pay for critical services that can be used to prevent the tens of thousands of unnecessary deaths we continue to see each year by the opioid crisis.

By Heather Stith
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The spread of COVID-19 forced everyone to reset their Summer 2020 expectations. I spoke with hc1’s five summer interns and Talent Acquisition Manager Keegan Jiles about the lessons they learned from this unusual internship season.

The biggest difference this year for the interns, and the rest of the hc1 staff, is that we all were (and still are) working from home instead of the office. Although the hc1 culture was evident in the banter during Google Meet department meetings and in Slack channel memes and photos, the usual in-office hc1 camaraderie was a casualty of COVID-19. Comparing last year’s experience to this year’s, returning intern Jake Baker missed things like hanging out working with others in the hc1 warehouse or talking about non-work stuff while grabbing lunch from food trucks in the office park. Product marketing intern Bonnie Bostic noted, “I wasn’t able to develop relationships with as many hc1 employees as I may have had the situation been normal.” 

TechPoint Xtern Daniel Knopf, who worked from his home in New York instead of living in downtown Indianapolis for the summer, said that although there were not many opportunities to make personal connections, he felt the learning experience was similar to how it would have been otherwise.  First-time intern Alissa Honingford agreed with Daniel’s assessment, “For me, it was still a great learning experience.”

Key to that learning experience was the fact that each intern had their own hc1 mentor/manager who met with them daily to discuss progress.  Keegan felt it was important for the interns to know they could come to him or the mentors with concerns and questions and for the mentors to have regular one-on-one meetings with the interns for feedback. 

At the beginning of the summer, Alissa was “introduced to a bunch of things I’d never heard of before.” By the end of July, she was able to apply her new knowledge with minimal input from her mentor to build a user interface to simplify hc1’s development work with Amazon EventBridge rules. Jake also focused on front-end work, building a user interface for work hc1 is doing with the FHIR electronic health record standard. “I’d never really worked with UIs before, but I really enjoyed it. And it’s meant to replace a tool that I had to work a lot with last year, that I did not like using, so I kind of saw a direct application for it, which was nice.” Bonnie’s favorite project was a graphic displaying the problems that hc1 customers face that will be used in future product marketing efforts.

Daniel and Ryan Klinedinst, also an Xtern,  both expanded existing skills. Daniel was able to see a code project through from start to finish plus do parallelization, which he had never done before. Ryan was productive right away, completing several small projects for the software engineering team before moving on to the data engineering team to work on a lab test matching model. He found that project to be the biggest challenge and also the most interesting concept to work on. All of the technology interns commented that going through the process of putting code into production was a valuable learning experience.

I asked the interns what else they learned or found surprising about the professional environment as opposed to an academic one. “A lot of meetings—that surprised me,” Daniel said with a smile. “How everything ties in, how all the teams work together, was something I found pretty interesting,” Ryan said. Bonnie discovered that work, can actually be incredibly motivating and inspiring. I found myself wanting to complete each new project.”

What did this year’s crop of interns take away from their 2020 summer experience? “I personally had no idea that there was an Indiana tech scene at all before the Xtern program,” Daniel said. “I’d never considered coming anywhere in the Midwest to do technology, but I say that now with the Xtern program and all, it’s definitely something that’s on my radar.” Alissa said, “This summer will help me choose classes that I’m actually interested in, rather than kind of going random. I can actually understand what I’m trying to choose and where I want to go with them.” For Ryan, who has a dual-track major in software engineering and machine intelligence, “Getting both experiences during the internship with the dev team and the data team was definitely super helpful for me. Before this, I was more leaning toward data science-type careers, and I think this definitely solidified, more or less, my interest in that.” 

“The point of an internship is so you can get a dope job, right?” Keegan said. Before the interns’ last day, he helped them write recruiter-ready resumes. “You’ve got to be able to help me read between the lines. Talk about your technologies. Don’t be so humble about it. You cannot assume that I [as the recruiter] know what you’re trying to say. So here’s how you take everything you did this summer and make it sexy,” he said. “That’s something that’s unique with hc1 is really setting them up for success after they finish their internship.” Keegan’s goal for every hc1 intern was “You’ve got to know what you did, and you’ve got to know what people care about that you did.” 

To learn more about hc1 opportunities, visit our Careers page.

By Lauren VanDenBoom
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October 15, 2019

Approximately 70 percent of medical decisions are based on pathology and laboratory test results.  Studies have shown, however, that 10 to 30 percent of the estimated 13 billion tests performed in the United States each year are either unnecessary or inappropriate.

When selecting from the thousands of laboratory tests available, healthcare providers need the best support possible to choose appropriate testing that will give the most guidance for a patient’s care. Through the support, they offer healthcare providers, laboratory stewardship and utilization programs can reduce unnecessary and inappropriate testing, as well as significantly lower costs and improve patient satisfaction and safety.

According to Guidelines by the National Committee for Lab Stewardship, a key element in successful stewardship programs is a strong commitment from health system leadership. Involvement from leaders helps to ensure the program has the right human, financial and technology resources.

To help ensure a utilization program is successful, health system leaders can:

  1. Declare support for the program. Publish formal statements that the health system supports efforts to improve laboratory stewardship. The statement should come from a leadership committee, medical director or even the health system president.
  2. Insist on cross-departmental involvement. Laboratory stewardship is not a laboratory-only activity. All participants in patient care who interact with laboratory testing and results have a role to play.
  3. Make stewardship an official responsibility. Include stewardship activities in job descriptions and annual performance reviews.
  4. Allocate time. Make sure all participants in the program are given sufficient time to contribute to its success.
  5. Enlist an experienced data partner. Products like hc1’s Test Utilization™ help transform laboratory data into actionable insights. Test Utilization provides a real-time dashboard of standardized and organized lab data from across the entire health system, including in-hospital, outpatient and reference lab data. With all of the data in an easy-to-use dashboard, identifying room for improvement in test utilization becomes simple.

The savings that can be realized through implementing an effective utilization program can more than makeup for the expense of putting the appropriate resources and team in place to do so. Estimates project that healthcare systems could reduce costs of up to $5 billion per year if they were just to eliminate redundant tests.

For more information about how you can ensure success for your laboratory utilization program, request a demo of hc1’s Test Utilization™.

References

  1. Dickerson, J. A., Fletcher, A. H., Procop, G., et al. (2017 Sept). Transforming laboratory Utilization review into laboratory stewardship: Guidelines by the PLUGS National Committee for Laboratory Stewardship. JALM. 259-268.
  2. (2017 May 30). Advancing Value-Based Healthcare: Laboratory Medicine’s Essential Role. https://www.aacc.org/health-and-science-policy/advocacy/position-statements/2017/advancing-value-based-healthcare-laboratory-medicines-essential-role
By Lauren VanDenBoom
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November 12, 2020

On Tuesday, November 10, hc1 CEO and Founder, Brad Bostic, was honored as Indiana Chamber’s 2020 Dynamic Leader of the Year by the Indiana Chamber of Commerce during their annual Awards event. This year the event was held virtually online.

Brad has been a leader in Indiana tech-based organizations for more than 20 years. He founded hc1 nearly a decade ago with the purpose of personalizing healthcare. Since then, he and the team at hc1 have removed silos and streamlined the process of turning raw healthcare data into actionable insights for better patient care at lower costs. 

Since its launch in 2011, hc1 has integrated over 22 billion clinical transactions and over 160 million unique patient profiles – numbers that grow daily. hc1 is the best in the world at identifying the signals, or hidden risks, in data to make precision health accessible to all patients.  

“We are in position to do something really special here as we emerge from the pandemic, and I look forward to putting Indiana on the map for the leader in bioinformatics for making the world we live in a better safer place for us all,” said Brad in his acceptance of the award. 

Click here to view the recording of Brad’s recognition during the event. To view the full awards show visit here.

Read more about Brad’s story from Bizvoice Magazine. To see all of the honorees and learn more from the Indiana Chamber of Commerce, visit here.

By Lauren VanDenBoom
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September 14, 2020

A recent study published in BMJ Open found that 72% of the 98,000 opioid-naive patients studied received a prescription for opioids following outpatient knee arthroscopy between 2015 and 2019. 

With more than 70,000 patients receiving opioids for the first time, I wonder how many received the risk assessment and monitoring that guidelines recommend.  

While the study doesn’t assess patient monitoring activities, 36% of the patients received a dosage higher than the recommended threshold of no more than 50 MME per day and no more than 6 days supply. This suggests to me that for at least a little over a third of the patients guidelines weren’t strictly followed. 

It’s just knee surgery. It’s just an average 5-day supply, a median tablet count of 40 tablets and a dosage of 250 MME. Why does it matter?

  • Because some patients may have a personal or family history of addiction.
  • Because sometimes the first prescription isn’t enough. Some patients will need a refill and begin a longer opioid treatment regimen than initially expected. 
  • Because some patients may have members of their household who are tempted to misuse improperly stored or disposed of opioids. 
  • Because opioids are a highly addictive controlled substance

An opioid-naive knee surgery patient doesn’t usually become an overdose statistic overnight. They start out taking their initial prescription and maybe have more pain than expected. They get a refill. Then maybe another refill, but at a higher dose, because over time as their body has become more dependent on the opioids the lower dose isn’t working as well. Then their first prescription isn’t working well enough, so they start taking more pills in a day and run out early, so they get a second prescription maybe even from another doctor. After a while, the second doctor becomes uncomfortable with prescribing more and they seek another source, maybe another family member or a friend. As the costs add up or sources become harder to come by they may start to dabble with illicit drugs too. Over the course of weeks or months a bad situation has developed.  

There are many other possible stories that could be told, like a teen or caregiver borrowing from the medicine cabinet or a sober alcoholic now tangling with a new addiction. No matter the situation, at multiple points in the progression from the knee surgery to opioid misuse to opioid addiction a healthcare provider who was carefully monitoring the patient’s opioid use with laboratory testing and PDMP checks could have spotted the concerning behavior and taken action to stop the progression. 

The right test, the right prescription, the earlier the intervention, the better the outcome for the patient.

References

Ukert B, Huang Y, Sennett B, et alState-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015–2019 BMJ Open 2020;10. https://bmjopen.bmj.com/content/10/8/e035126 

 

By Heather Stith
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09/15/20

Diversity in drug clinical trials and other drug research is important because patients often respond to the same dosages of the same drug in different ways. The drug can work exactly as intended in one patient with minimal side effects. Another patient might not see any improvement or, worse yet, might experience severe side effects. Documented variations in drug response help prescribers to determine which drugs will work best for their patients.

These variations occur because patients’ bodies process drugs differently. The term for this process is pharmacokinetics. Pharmacokinetics involves several stages: absorption, distribution, metabolism, and excretion. Patient characteristics and drug chemistry determine how pharmacokinetics work when a patient takes a prescription. For example, patients who metabolize a drug quickly may need a larger dose for the drug to work as intended or may need to take a different drug to see any benefit. Patients who metabolize the drug at a medium rate are likely to experience the full benefit of the drug. Patients who are slow metabolizers may need a smaller dose of the drug to avoid side effects or may not be able to take the drug at all because of the severity of side effects.

To help prescribers predict how a given drug will affect an individual patient, research has identified many patient characteristics that affect the pharmacokinetics of drugs. Age, weight, sex, liver and kidney function, and diet all have proven pharmacokinetic implications. Even with this information, prescribers face obstacles in determining the right prescription because many patient factors that affect pharmacokinetics are harder to pinpoint. As a result, patients often endure a prolonged trial-and-error prescription process as prescribers go through the cycle of adjusting dosages, monitoring effects, and trying different drugs until they find the right one to meet an individual’s needs.

The goal of pharmacogenetics, which is the study of how variations in genes affect how a patient metabolizes certain drugs, is to prevent side effects and shorten the time it takes to establish the most effective medication plan for a patient. A pharmacogenetic (PGx) test involves taking a sample of the patient’s DNA and evaluating it for the genetic variations in the enzymes that metabolize drugs. The results of this test must be evaluated against current knowledge about how specific drugs interact with specific genes.

Developing this type of personalized medication plan across a large patient population takes coordination, organization, engagement, and monitoring, and that’s how the award-winning hc1 PGx Advisor® can help. It unifies PGx test results with the latest PGx drug information and facilitates patient engagement and monitoring to ensure that patients get the maximum personalized prescription benefit from PGx testing. Click here to learn more about how hc1 PGx Advisor® can improve patient outcomes while reducing overall medical costs.

By Lori Smith, PHR
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May 27, 2021

Editor’s note:  Who we are as a company has been on our minds lately here at hc1. It’s just as important as what we do, because each individual on our team contributes something of themselves to the solutions we deliver. So we asked Lori Smith, PHR our SVP of Talent, to share her perspectives on the team and talent that are hc1.

In honor of Mental Health Awareness Month, and as hc1’s Talent leader, I would be remiss if I didn’t acknowledge the impact of the past year – both personally and professionally. I feel effective role modeling from leadership is one of the most powerful drivers in ensuring people take care of their mental health. The shame of talking openly about mental health is finally diminishing, but it’s no secret mental health has historically had a negative stigma associated with it. 

I can say that from an HR perspective, the increased awareness around mental health is an invaluable outcome of 2020. As a human, I also recognize there is a crucial difference between May 2020 and May 2021 – we have all lived through 14 months of pandemic life. 

Work. Sleep. Repeat.

When the office first shut down, we were all isolated but with purpose. My team and I went into overdrive, reaching out to our people and making sure they felt supported and connected. The escalated focus on employee wellbeing that erupted during that time helped remove some of the awkwardness as we were asking people how they were feeling. There was mutual value being exchanged between me/my team and our team members. 

Before we knew it, the two-week office shut down quickly turned into ten months. On many levels, self-care was missing and/or severely lacking. For me, I couldn’t pinpoint on just one or two things. It wasn’t just work, personal or hearing about COVID nonstop – every day felt like it was groundhogs day and frequently felt varying degrees of “feeling off” – just in a different hc1 shirt. Enter Phase Burnout…

Clear as mud. 

According to the World Health Organization (WHO), mental health is “a state of wellbeing in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.” 

What is considered “normal” stresses of life? A pandemic isn’t “normal”. What does “work productively” mean exactly? I’ve had many days when I showed up physically and made contributions to my work/team, but mentally, I was exhausted and ended the day feeling incredibly unproductive. How about “can cope”? If that can be defined by putting on a clean hc1 sweatshirt and almost clean jeans, then I had been killing it – right? 

Reconnecting with Purpose

So what is the difference between “normal” mental health and mental disorders? Sometimes it’s clear – and well, sometimes it’s just not. If someone feels bad and it affects their day-to-day life, it’s a mental health concern. 

We can’t expect people to go through 14 months (and counting) and assume everyone will come out the other side being fine. Those effects should be considered, even if we’re walking around maskless and vaccinated. 

Many will recover uneventfully; for others, the pandemic was a disruptive inconvenience, but it has been unexpectedly punishing for a lot of us. Key takeaway – not only is mental health hard to measure, but it is also even easier to ignore. 

Making sure that you are meeting your mental health needs is critical. Like I said before, the past 14 months haven’t been easy, and recognizing that you are struggling is okay. The below resources can help you learn more about how you can support Mental Health Awareness Month and your own wellbeing. 

By Lori Smith, PHR
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As today marks National Intern Day, we are taking a moment to showcase and thank our talented group of hc1 interns including Evan Klein, (Butler University), Benjamin Huang (Purdue University) and Srikar Namburi (Rose-Hulman) who all took part in hc1’s summer internship program.

Exploring is a vital part of the college experience. While the overarching goal of higher education is to prepare students to achieve success in their future careers, the purpose of an internship is to provide real-world experience and use that opportunity by putting what has been learned into action.  More importantly, it helps them decide whether or not it’s a path they can picture spending their career doing.

hc1 recognizes internships are a great way for students to acquaint themselves with the field they are interested in. Gaining important life skills can be considered crucial aspects of career preparedness, the hands-on work experience interns receive is invaluable. 

“hc1 is an incredible company and gave me a lot of insight as to how tasks are assigned, different teams communicate, and how a successful software company operates. Not only that, but I felt that hc1 provided valuable experience and familiarity with popular industry-tools like AWS Lambda. I couldn’t ask for a better way to learn and apply my skills in a constructive way.”  Srikar Namburi Software Engineer Intern

Our interns contribute by utilizing exposure to the latest technological trends to provide innovative ways to solve problems. We encourage them to try innovative ideas and find new ways to overcome challenges. We like to think of it as a fresh pair of eyes reviewing and finding kinks within our existing processes. 

Learning the specialized skills of a particular field, as well as transferable skills such as communication, teamwork, and industry knowledge, gives them a leading edge as they enter the workforce. 

“My time at hc1 has been a great learning experience that has allowed me to expand on the current knowledge that I have gained from pharmacy school and apply it to the technology that hc1 has developed to improve many areas within healthcare. Seeing the way that different teams collaborate throughout hc1 shows the unity that everyone has towards each other and really makes for an enjoyable work environment. I’m very grateful to have had this opportunity to work with an awesome group of people who have passion for what they do.”  Evan Klein PRx Intern

Mentoring and guiding others has always been an incredibly rewarding and motivating experience for the interns and hc1 managers. The relationship that is cultivated over the summer has a lasting impact long after the internship ends. 

“My mentor, Scott, inspires me to do my best work every day. During the onboarding process, I had to configure and install a lot of stuff and I ran into a lot of errors, but Scott was very understanding and helped me work through them. He’s also extremely knowledgeable and I invariably get an answer when I go to him with a question.”  Benjamin Huang Software Engineer Intern 

As members of our next generation of leaders, these summer interns brought the same energy and determination to hc1 that led to their selection in the first place. Their energy could be felt by the team and greatly enhanced our company culture.

Thank you for all of your efforts, commitment and dedication! We are all honored to be at the start of your professional journey! 

By Lauren VanDenBoom
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Over the next few weeks we will be highlighting some of the new features in hc1 4.0, beginning with the Create Opportunity Wizard, which streamlines communication across departments – without derailing sales opportunities. (more…)

By Carson Goff
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October 28, 2019

Pharmacists are increasingly playing a role in opioid stewardship programs. The recently published results of the National Survey of Pharmacy Practice in Hospital Settings – 2018 found that 70 percent of pharmacists play a role in diversion detection and 57 percent are likely to be involved in clinical utilization review.

The survey, which analyzes the pharmacy’s role in drug therapy monitoring and patient education, included responses from pharmacy directors in 811 U.S. general and children’s hospitals.

The pharmacy directors who responded indicated that the most common strategies their hospitals are employing for opioid stewardship programs are clinician education (71 percent), prescription drug monitoring program checks (65 percent) and diversion detection programs (55 percent).

The Centers for Disease Control and Prevention (CDC) encourages pharmacists to take an active role in preventing opioid misuse. The CDC asks them to look for “red flags” that could indicate a patient might be struggling with opioid use disorder or diverting medications. This can be done through checking the state’s prescription drug monitoring program (PDMP) or a patient’s records.

The CDC encourages pharmacists and prescribers to work together as part of the care team. The pharmacist should contact the prescriber with questions or concerns, talk to the patient and submit information to the PDMP.

Both the survey and the CDC place the pharmacist in a role as patient educator alongside the prescriber. The CDC recommends that pharmacists counsel patients on:

  1. Proper use of their medication
  2. Side effects
  3. Expectations surrounding medication refills
  4. The dangers of stockpiling medication
  5. Safe storage and disposal

Keeping lines of communication open is critical so that pharmacists and prescribers can work hand-in-hand to prevent opioid misuse. For additional tips on communicating with patients and ways a pharmacist can start a conversation, read the CDC’s handout Pharmacists on the Front Lines.

 

 Sources

  1. ASHP (American Society of Health-System Pharmacists). (3 July 2019). Hospitals address opioid crisis via stewardship with strong pharmacist involvement. Medical Express. https://medicalxpress.com/news/2019-07-hospitals-opioid-crisis-stewardship-strong.html
  2. Dyson, T. (3 July 2019). Opioid stewardship programs help prevent misuse in hospitals. UPI. https://www.upi.com/Health_News/2019/07/03/Opioid-stewardship-programs-help-prevent-misuse-in-hospitals/1571562178660/
  3. Pharmacists: On the front lines addressing prescription opioid abuse and overdose. https://www.cdc.gov/drugoverdose/pdf/pharmacists_brochure-a.pdf