bluuebunny/crossref_metadata_2025 huggingface dataset:
Over-the-Counter Medication Use, Perceived Safety, and Decision-Making Behaviors in Pregnant Women
Authors: Kline Katie L. , Westberg Sarah M.
Published: January 2018

The purpose of this study was to determine which over-the-counter (OTC) medications women are using during pregnancy, and to assess patients' perceived safety of these medications. In addition, the decision-making process utilized by pregnant women when choosing OTC drug therapy was explored, including sources of information and recommendation.

The subjects included pregnant women 18 years and older. Subjects were solicited as a convenience sample by providing surveys in two urban women's clinic waiting rooms. Of the 61 respondents, 96.3% had used an OTC medication, herbal, or vitamin during their current pregnancy. The most common products included prenatal vitamins, acetaminophen, cough drops, antacids, calcium, vitamin D, and DHA. The majority of women surveyed regarded over-the-counter medications, vitamins, and herbals as "safe, but would talk to a healthcare professional before using." The most utilized sources of drug information during pregnancy were a physician (68.9%), midwife (55.7%), and the Internet (44.3%). There were an equal number of respondents obtaining general OTC information from a pharmacist as from their family and friends (26.2%).

Almost all subjects had used an over-the-counter medication during their pregnancy and the majority considered OTCs safe after first consulting a healthcare professional. Although a high percentage of subjects have obtained their information and recommendations from healthcare professionals, a very small proportion of subjects had utilized a pharmacist as a resource. Being drug experts and easily accessible members of the healthcare team, pharmacists have a responsibility to aid the obstetric population in the appropriate and safe use of over-the-counter drugs, vitamins, and herbals during pregnancy.

Type: Student Project
Evaluation of a Continuing Professional Development program for first year student pharmacists undergoing an Introductory Pharmacy Practice Experience
Authors: Tofade Toyin , Franklin Brianna , Noell Bennett , Leadon Kim
Published: January 2018

Objectives: The purpose of the study was to evaluate a live and online training program for first year pharmacy students in implementing Continuing Professional Development (CPD) principles (Reflect, Plan, Act, and Evaluate), writing SMART learning objectives, and documenting learning activities prior to and during a hospital introductory professional practice experience.

Design: Cohort Study.

Setting: Introductory professional practice experience.

Participants: First year (PY1) students at the University of North Carolina Eshelman School of Pharmacy.

Intervention: Live training or online training to introduce the concept of Continuing Professional Development in practice.

Main Outcomes: Implementation of CPD principles through 1) completed pre-rotation education action plans with specific, measurable, achievable, relevant and time-bound (SMART) learning objectives; and 2) completed learning activity worksheets post-rotation indicating stimuli for learning, resources used and accomplished learning. objectives; and 3) documented suggestions and content feedback for future lectures and pharmaceutical care lab experiences.

Results:Out of the whole cohort (N=154), 14 (87.5%) live (in person) trainees and 122 (88%) online trainees submitted an education action plan. Objectives were scored using a rubric on a scale of 1-5. A rating of 5 means "satisfactory", 3 means "work in progress" and 1 means "unacceptable". There were significant differences between the mean live trainee scores and the mean online trainee scores for the following respective section comparisons: Specific 4.7 versus 3.29 (p

Conclusion: Live trainees performed significantly better than online trainees in writing SMART learning objectives. With focused training, students are more capable of implementing principles of CPD.

 

Type: Original Research
Pharmacists' social authority to transform community pharmacy practice
Authors: McPherson Timothy , Fontane Patrick
Published: January 2018

Leaders in the profession of pharmacy have articulated a vision of pharmacists as providers of patient-centered care (PCC) services and the Doctor of Pharmacy was established as the required practice degree to achieve this vision. Pharmacist-provided PCC services have been shown to reduce medication costs and improve patient compliance with therapies. While community pharmacists are capable of, and are ideally placed for, providing PCC services, in fact they devote most of their time to prescription dispensing rather than direct patient care. As professionals, community pharmacists are charged with protecting society by providing expert services to help consumers manage risks associated with drug therapies. Historically pharmacists fulfilled this responsibility by accurately dispensing prescription medications, verifying doses, and allergy checking. This limited view of pharmacy practice is insufficient in light of the modern view of pharmacists as providers of PCC. The consumers' view of community pharmacy as a profession represents a barrier to transforming the basis of community pharmacy from product distribution to providing PCC services. Community pharmacists are conferred with social authority to dictate the manner in which their professional services are provided. Pharmacists can therefore facilitate the transition to PCC as the primary function of community pharmacy by exercising their social authority to engage consumers in their roles in the new patient-pharmacist relationship. Each pharmacist must decide to provide PCC services. Suggestions for initiating PCC services in community pharmacy are offered.

 

Type: Idea Paper
What's Past is Prologue: The History of the Discipline of Pharmacy Administration
Authors: Bonnarens Joseph K.
Published: January 2018

Type: Commentary
Providing Health Care Service-learning Experiences for IPPE Credit
Authors: Bartelme Kassandra M. , Ticcioni Andrew J. , Janke Kristin K.
Published: January 2018

Service-learning (SL) provides an opportunity for students to learn personal and professional skills while providing a useful service to the community. Many pharmacy education programs use SL within their curriculum because of the benefits to the community, the faculty, the learning institution and the student(s). While SL has been used in schools/colleges of pharmacy for many years, SL that also fulfills IPPE requirements is newer. This paper seeks to promote the use of combined SL/IPPE experiences. It provides an example where students volunteered at federally qualified health centers and also reviews the ACPE Standards related to SL. Schools/colleges of pharmacy are encouraged to design mechanisms for students to participate in combined SL/IPPE experiences as part of their IPPE requirements.

 

Type: Idea Paper
Patient And phaRmacit Telephonic Encounters (PARTE) in an Underserved Rural Population with Asthma: Methods and Rationale
Authors: Young Henry N. , Havican S. Nadra , Chewning Betty A. , Sorkness Christine A. , Ruppel Xin , Griesbach Sara
Published: January 2018

Purpose: Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described.

Summary: In a randomized controlled trial (RCT), the Patient And phaRmacist Telephonic Encounters (PARTE) project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center. Ninety-eight participants have been randomized to either standard care or the intervention group who received consultation and direct feedback from pharmacists via telephone regarding their asthma self-management and medication use. Pharmacists used a counseling framework that incorporates the Indian Health Services 3 Prime Questions and the RIM Technique (Recognition, Identification, and Management) for managing medication use problems. Pharmacists encouraged patients to be active partners in the decision-making process to identify and address the underlying cause of medication use problems. Uniquely, this trial collected process and summative data using qualitative and quantitative approaches. Pharmacists' training, the fidelity and quality of pharmacists' service delivery, and short term patient outcomes are being evaluated. This evaluation will improve our ability to address research challenges and intervention barriers, refine staff training, explore patient perspectives, and evaluate measures' power to provide preliminary patient outcome findings.

Conclusion: A mixed method evaluation of a structured pharmacist intervention has the potential to offer insights regarding staff training, service fidelity and short term outcomes using quantitative and qualitative data in an RCT. Results will provide evidence regarding the feasibility and quality of carrying out the study and service delivery from the multiple perspectives of participants, clinicians, and researchers.

 

Type: Original Research
Pharmacist-Driven Management of Chemotherapy Induced Nausea and Vomiting in Hospitalized Adult Oncology Patients. A Retrospective Comparative Study
Authors: Elshaboury Ramy , Green Kathleen
Published: January 2018

Chemotherapy-induced nausea and vomiting (CINV) is a major adverse event associated with cancer treatments. There are clinical practice guidelines that assist practitioners in managing CINV. Many cancer centers develop protocols for physicians and pharmacists to guide prophylaxis and breakthrough treatments of CINV based on published guidelines. The purpose of this study was to evaluate the outcome differences between pharmacist and physician -driven management of CINV in adult hospitalized cancer patients in a large academic medical center. This is a single center retrospective chart review study. The primary outcome of the study was the number of breakthrough antiemetic doses needed throughout the hospitalization. A total of 106 adult patients receiving inpatient chemotherapy were reviewed for CINV management. Fifty-five patients (52%) were managed according to the pharmacist-driven protocol, and fifty-one patients (48%) were managed by the physician. There was no difference between the two groups in the primary outcome. Patients in the pharmacist-managed group needed 6.4 breakthrough antiemetic doses; whereas, patients in the physician managed group needed 5.9 doses throughout the hospital stay (P-value = 0.7). No difference was seen when results were adjusted for length of hospitalization. There was a difference in adherence to the institution CINV guidelines favoring the pharmacist-driven approach (85% versus 33%, P < 0.0001). In conclusion, pharmacist-run protocol for CINV management was as effective as the standard of care. Protocols that are based on practice guidelines may offer the advantage of care standardization and potential cost savings.

 

Type: Student Project
Development and Implementation of a Novel Lifestyle Medicine Advanced Pharmacy Practice Experience Elective
Authors: Gillespie Nicole D. , Lenz Thomas L.
Published: January 2018

Objective: To develop and implement an Advanced Pharmacy Practice Experience (APPE) to increase student's awareness and use of lifestyle modifications in chronic disease prevention and management.

Design: A five-week APPE was developed that utilized a wide variety of activities, including direct patient care, patient education, case studies, journal clubs and reflective assessment and writing to explore various lifestyle modifications and their relation to chronic disease prevention and management.

Conclusion: The novel lifestyle medicine APPE provides students a unique opportunity to advance their knowledge in therapeutic lifestyle changes and expand their understanding of the pharmacist's role in chronic disease prevention and management.

 

Type: Idea Paper
Remember Your MEDS: Medication Education Delivers Success
Authors: Rife Kelsey M. , Ginty Sarah E. , Hohner Elizabeth M. , Stamper Heather R. , Sobota Kristen F. , Bright David R.
Published: January 2018

Background: Medication adherence is one of the largest barriers to better patient outcomes today. As pharmacists and student pharmacists expand their roles with community outreach projects, they have the potential to make a huge impact on improving adherence.

Objective: To improve medication adherence through patient counseling and constructive resources, and to determine patient preferences of adherence tools.

Methods: Student pharmacists partnered with a 340B pharmacy to promote the importance of medication adherence. Patients were counseled in an initial 10 minute session, and then given the opportunity to receive one or more of the following adherence tools: a pill box, timer, reminder refrigerator magnets, calendar stickers, refill reminder phone calls and/or text message reminders. A pre-survey was conducted to establish the patients' baseline medication adherence using the validated ©Morisky Medication Adherence Scale (©MMAS-8). After three months, students conducted the post-survey via the ©MMAS-8 by calling the patients and asking them questions about the helpfulness of the adherence tools as well as the effectiveness of the initial counseling visit.

Results: Sixty five patients with hypertension enrolled in the study, and 51 patients completed both the pre- and post-surveys. Patients improved from a 6.02 (SD +/- 1.62) average pre-score to a 6.83 (SD +/-1.25) average post score (p < 0.001). Pill boxes, text message reminders, and calendar stickers were respectively ranked as the top 3 most helpful tools studied. The refrigerator magnets were also considered helpful by most patients who used them. The timers were ranked the least helpful, mostly due to difficulty of use.

Conclusion: Student pharmacists can have a positive impact on medication adherence through simple counseling and offering effective adherence tools.

 

Type: Student Project
What We Can Expect from Consumer-Driven Health Care
Authors: Park Taehwan
Published: January 2018

Type: Commentary
Impact of Pharmacists and Student Pharmacists in Educating and Screening Low-Income Women for Cardiovascular Disease
Authors: DiPietro Natalie A. , Sobota Kristen Finley , Giannamore Martin R.
Published: January 2018

Objectives: To evaluate the effectiveness of an educational intervention on knowledge of cardiovascular disease (CVD) and to increase awareness of risk factors among female patients of a community health center with an on-site 340B pharmacy.

Methods: The program consisted of a 10-minute educational intervention and brief pre-test, post-test, and participant satisfaction survey. Adult female patients at the clinic for any provider visit or prescription fill were eligible to participate. Participants met individually with a student pharmacist or faculty member and verbally completed the pre-test. The participant received education regarding CVD, risk factors, and symptoms of myocardial infarction and were screened for hypertension and/or hyperlipidemia. The post-test was then verbally administered. Participants answered the satisfaction survey privately. Based on individual needs, educational materials and information on available pharmacy clinical services were provided. The university IRB deemed the study exempt.

Results:Eighty-four individuals received educational materials and/or a screening test. Of those, 30 women (mean age 46.9 years) completed the educational intervention. Thirteen (43%) reported smoking; 22 (73%) identified themselves as overweight. Fourteen (47%) indicated a preexisting diagnosis of hypertension. Correct responses for 6 of 8 knowledge-based questions were statistically significantly improved from pre-test to post-test (p

Conclusion: CVD is the leading cause of death in U.S. women. Data from this program indicate that through screening and education, pharmacists and student pharmacists can impact female patients' knowledge of CVD risk factors. Continued efforts in this area may help to reduce the public health burden of CVD.

 

Type: Student Project
Clinical Pharmacy: A Theoretical Framework for Practice
Authors: Adjei Michael
Published: January 2018

Type: Idea Paper
Commentary for Medication Adherence of Patient Assistance Program Recipients: A Pilot Study
Authors: Rickles Nathaniel M.
Published: January 2018

Type: Commentary
The Effect of Pharmacist Intervention on Diabetes Screening Promotion and Education in a Geriatric Population
Authors: Pol Alicia , Gillespie Nicole , Knezevich Emily , Ryan-Haddad Ann
Published: January 2018

Type: Student Project
Don't Leave Without Them: Dispensing asthma medications to pediatric patients upon discharge is associated with decreased hospital readmissions
Authors: Hiteshew Kelly J. , Franz Thaddeus , Lamberjack Kristen , Chen Aleda M.H.
Published: January 2018

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution's outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy.

Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test.

Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; x2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; x2 = 929.04, p < 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; x2 = 52.5; p < 0.001).

Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.

 

Type: Original Research
Development of a Medication Monitoring System for an Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) Team
Authors: Watkins Sarah C. , Winchester Bruce R. , Brahm Nancy C. , Washington Nicole B.
Published: January 2018

Purpose: The primary goal was to improve medication management oversight for a severely mentally ill (SMI) community-based population by developing a medication monitoring system based on current guidelines to optimize pharmacotherapy and minimize potential medication-related adverse effects. The secondary goal was improvement in coordination of care between healthcare providers.

Methods: Guidelines for medication used for psychiatric indications were reviewed. A database of medication for psychiatric indications with monitoring recommendation was developed.

Results: Medication regimens for 68 members of the Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) program qualified for review. Fourteen medications, carbamazepine, chlorpromazine, clozapine, fluphenazine and fluphenazine long-acting injections (LAI), haloperidol and haloperidol LAI, lithium, lurasidone, olanzapine, paliperidone and paliperidone LAI, perphenazine, quetiapine, risperidone and risperidone LAI, valproic acid/divalproex, and ziprasidone, were identified. In total, 111 medications are used on a monthly basis. Each member receives more than one medication qualifying for review. Additional monitoring parameters that were evaluated included changes in laboratory orders for members with insulin-dependent diabetes. Annual lipid panels were changed to every 6 months, if applicable.

Conclusions and Future Directions: This medication monitoring program was developed to help ensure IMPACT members receive the most effective care and minimize potential medication-related adverse effects. The secondary goal was to improve coordination of care. Medication monitoring will be added as a continuous quality assurance measure. Lab results will be reviewed at least monthly. The medication monitoring program will be evaluated annually.

 

Type: Student Project
Consumer Reports - Best Buy Drugs' Outreach Project in Minnesota
Authors: Schommer Jon C. , Worley Marcia M. , Schondelmeyer Stephen
Published: January 2018

The objectives for this study were to apply four different approaches for disseminating Consumer Reports Best Buy Drugs (CR-BBD) information about effectiveness, safety, and cost to patients for therapeutic classes of medications that they were using and then (1) evaluate the usefulness of the information to participants and (2) document resultant information seeking. For the three approaches that utilized face-to-face contact (Approaches 2 through 4), we also compared them in terms of (1) number of medications reviewed per person, (2) availability of CR-BBD information per person, (3) changes that could be made for each person, and (4) potential/likely cost savings (per person per month). Finally, we described the availability of CR-BBD information for each participant categorized by the 19 therapeutic classes of medications for which there were Best Buy Drugs reports. Data were collected via self-administered surveys, in-person interviews, and telephone interviews. The results showed that almost all of the participants in the information sessions held for this study had at least one medication for which Best Buy Drug information was available with significant savings potential to be gained by using the recommended Best Buy Drug. Potential cost savings through the use of recommended Best Buy Drugs was $89.47 per person per month averaged over all participants (n = 172) and was $157.20 per person per month for those with savings over zero dollars (n = 98). Thirty-two percent of respondents to our evaluation survey reportedly sought more information from a physician and 30 percent sought more information from a pharmacist. We concluded that provision of information about effectiveness, safety, and cost to patients has the potential for achieving significant cost savings. Recommendations regarding (1) the timing of provision, (2) targeting of recipients and (3) traversing impediments are given.

 

Type: Original Research
Cultivation and Implementation of Community-Engaged Pharmacy Services in a Free Clinic to Enhance Care for the Medically Underserved
Authors: Tran Emmeline , Jennings Brandon T.
Published: January 2018

Partnerships between community free clinics and academic medical centers improve patient outcomes and enhance learning opportunities for students. A community-academic partnership between the Maliheh Free Clinic and the University of Utah College of Pharmacy was formed to fulfill a community need for pharmacy services, to promote interdisciplinary patient care, and to provide an experiential opportunity for students. The Maliheh Free Clinic based in Salt Lake City, Utah provides free primary health care to uninsured individuals who live 150% below federal poverty guidelines. Three pharmacy services were developed and implemented. These include: 1) clinic chart reviews which involve written recommendations following a comprehensive assessment of the patient's chart examining his or her disease states and the appropriateness of his or her medications; 2) medication reconciliations and discussion of pharmacy-related recommendations with patients during Diabetes Day, an inclusive interdisciplinary patient appointment that addresses important aspects of diabetes care; and 3) an insulin dose adjustment service through a collaborative practice agreement with the clinic to monitor a patient's blood glucose levels and adjust his or her medications accordingly on a weekly basis.

 

Type: Student Project
Developing a Respiratory Depression Scorecard for Capnography Monitoring
Authors: Felhofer Katie
Published: January 2018

Pulse oximetry is the most common way to measure a patient's respiratory status in the hospital setting; however, capnography monitoring is a more accurate and sensitive technique which can more comprehensively measure respiratory function. Due to the limited number of capnography monitoring equipment at the University of Minnesota Medical Center-Fairview (UMMC-Fairview), we analyzed which patients should preferentially be chosen for capnography monitoring over pulse oximetry based on risk of respiratory depression. We conducted a retrospective chart review of all serious opioid-induced over-sedation events that occurred at UMMCFairview between January 1, 2008 and June 30, 2012. Thirteen risk factors were identified which predispose patients to respiratory depression. The average patient demonstrated 3.75 risk factors. The most commonly occurring risk factor was the concomitant use of multiple opioids or an opioid and a CNS-active sedative, followed by an ASA score äŠ« 3. Based on this data, we developed a scorecard for choosing patients at the most risk of developing respiratory depression; these patients are the best candidates for capnography. Although further studies are necessary to corroborate this research, at this time giving extra consideration to patients demonstrating the previously stated risk factors is prudent when assessing those patients most in need of capnography.

 

Type: Student Project
The Role of Clinical Pharmacists in Modifying Cardiovascular Disease Risk Factors
Authors: Bagwell Autumn , Skelley Jessica W. , Saad Lana , Woolley Thomas , Dugan DeeAnn
Published: January 2018

Objective: Assess the effect of intensive clinical and educational interventions aimed at reducing risk factors for Cardiovascular Disease (CVD), implemented by clinical pharmacists, on modifying risk factors in targeted patients at high risk for CVD.

Design: Patients with at least two risk factors for CHD were identified at two clinics by conducting a pre-intervention survey and were monitored over a period of 6 months with follow up conversations conducted every 4 weeks by phone and at subsequent physician visits. A post-intervention survey was conducted at the end of the study period to detect modified risk factors.

Setting: The Jefferson County Public Health Department (JCHD)

Participants: We followed a total of 47 patients over 6 months. The average age at baseline was 51 years old and 80% of the participants were female. The baseline average number of modifiable cardiovascular disease risk factors was 3.7.

Measurements: We assessed total number of CVD risk factors, smoking behavior, blood pressure, LDL, A1C, weight, and level of physical activity (major modifiable risk factors by the American Heart Association).

Results: Over a 6 month follow-up of 47 patients, statistically significant reductions occurred in total number of CVD risk factors, systolic and diastolic blood pressures, and A1C. Reductions also occurred in LDL level, weight, and changes in smoking behavior and physical activity were identified.

Conclusions: Results showed that increased patient counseling on adherence and lifestyle changes along with increased disease state monitoring and medication adjustment led by a clinical pharmacist can decrease risk factors in patients with multiple risk factors for cardiovascular disease.

 

Type: Student Project
Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention
Authors: DiPietro Natalie A. , Bright David R.
Published: January 2018

As medication therapy management (MTM) continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.

 

Type: Idea Paper
Fluconazole-Associated Birth Defects: A Comprehensive Review
Authors: Firth Janssen M. , Daniel Nicholas , Hughes Peter J.
Published: January 2018

Background: The August 2013 publication of a large historical cohort study in the New England Journal of Medicine has reignited interest in the potential teratogenic effects of fluconazole when used in pregnant females. Fluconazole is an effective and commonly-utilized antifungal medication. Thus, maternal and fetal exposure to fluconazole is expected in the general population, and pharmacists are expected to counsel patients regarding any risks to their prescribed treatment.

Methods: A literature review of all published literature indexed to PubMed (January 1966 to October 2013) and International Pharmaceutical Abstracts (January 1975 to October 2013) including fluconazole and teratogenic effects and published in the English language was conducted.

Results: Fourteen publications were included for analysis including case reports (n=7), cross-sectional research (n=2), and historical cohort studies (n=5).

Conclusion: There appears to be little to no fetal risk resulting from a single dose or short duration antifungal therapy with fluconazole. However, prolonged high-dose fluconazole therapy has increased potential to confer teratogenic effects. In those cases, the risks of such therapy should be weighed against potential benefits.

 

Type: Student Project
Addressing Clinical Faculty Need: Creating a Process and Evaluation for Peer Review of Practice
Authors: Moon Jean Y. , Reidt Shannon , Undeberg Megan , Schullo-Feulner Anne
Published: January 2018

Objectives: To describe the evolving process and evaluate the perceived value of peer review for clinical faculty.

Methods: Using a 5-point Likert scale, clinical faculty rated the value of an electronic peer review process by completing an electronic 30 item survey across six areas of clinical faculty practice-related activity. Based on feedback, modifications were made and faculty were re-surveyed the following year.

Results: Initially, 78% of faculty found peer review to be beneficial, mostly in the area of practice development and portions of practice dissemination. After modifications, 45% found peer review to be beneficial.

Conclusions: Clinical faculty are challenged to leverage their practice into teaching and scholarly activities; however, clinical faculty often need feedback to accomplish this. Although the peer review process was designed to address perceived needs of clinical faculty, the process is dynamic and needs further refinement. Overall, clinical faculty find value in a peer review process. This evaluation of peer review illustrates the challenges to provide feedback across six key areas of clinical faculty activity.

 

Type: Original Research
Time and Motion Study of Influenza Diagnostic Testing in a Community Pharmacy
Authors: Klepser Donald , Dering-Anderson Allison , Morse Jacqueline , Klepser Michael , Klepser Stephanie , Corn Carolyn
Published: January 2018

Background: It has been shown that use of rapid diagnostic tests (RDTs) is able to reduce costs and improve the prescribing practice of antivirals (i.e. oseltamivir) among patients with influenza-like illnesses (ILIs). Using existing Clinical Laboratory Improvement Amendment (CLIA)-waived RDTs and collaborative practice agreements, similar to those used to allow pharmacists to administer vaccines, it is possible for patients to seek point-of-care treatment for influenza or flu-like symptoms at a local pharmacy. Following a review of the patient's symptoms by a trained pharmacist, the qualified patient is offered an RDT to determine if the influenza virus is the cause of the symptoms. Based on the results of the RDT, the patient is provided with the appropriate treatment as defined by an approved practice agreement.

Objective: The aim of this study was to evaluate the feasibility of incorporating an RDT for influenza into community pharmacy practice.

Methods: This time and motion study was conducted at three community pharmacy locations, and a total of eight simulated patient visits were completed utilizing a standardized patient. In addition to determining a total time of the encounter, each simulation was divided into nine timed sub-categories. For data analysis, the time spent in each of the nine sub-categories was assigned to the pharmacist, pharmacy technician, or patient. Time and motion methodologies were used to estimate the total time required to provide the RDT service, to determine the amount of active time required of the pharmacist and pharmacy technician, and to evaluate the ability of the staff to provide the service within its existing workflow.

Results: The average total time to complete the entire patient encounter for an influenza assessment utilizing an RDT was 35.5 minutes (± 3.1 minutes). On average, the pharmacist spent 9.4 minutes (± 3 minutes) per encounter or about 26.5% of the entire encounter. When the pharmacy technician collected the vital signs, the pharmacist-required time was reduced to 4.95 minutes (± 2.7 minutes), which was about a 48% reduction.

Conclusions: The results indicate that an RDT program for influenza assessment required no more than a modest amount of pharmacist time and could be successfully incorporated into regular workflow with little to no disruption of other activities. As such, this approach to influenza management may be a feasible service for community pharmacies to offer patients. This was especially true if the pharmacy had well-trained technicians on staff that could support the service with collection of patient histories and vital signs.

 

Type: Original Research
Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8)
Authors: Tan Xi , Patel Isha , Chang Jongwha
Published: January 2018

Erratum

Redacted by authors in order to address a question regarding the use of a measure. 

 

Type: Original Research
Implementation of a financially incentivized weight loss competition into an already established employee wellness program
Authors: Schramm Andrew M. , DiDonato Kristen L. , May Justin R. , Hartwig D. Matthew
Published: January 2018

Objective: To assess improvement in clinical outcomes and patient satisfaction of a financially incentivized weight loss competition adjunct to a currently established pharmacist-directed employee wellness program.

Design: Retrospective, cohort, pilot study

Setting: 6 independent community pharmacy chain locations, two long-term care pharmacies, and a pharmacy corporate office in northwest and central Missouri, from January 2013 to April 2013.

Participants: 24 benefit-eligible patients employed by the self- insured pharmacy chain.

Intervention: A financially incentivized weight loss competition focusing on healthy lifestyle practices was implemented at nine pharmacy locations over an eight week period.

Main outcome measure(s): Change from baseline in mean total cholesterol, serum triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and body mass index (BMI). Patient satisfaction was also assessed after completion.

Results:24 patients completed the competition. The average weight loss among all participants was 10 ± 7.3 pounds. A mean decrease in serum triglycerides was significant at 36.9 mg/dL per participant (p

Conclusion: The implementation of a financially incentivized weight loss competition provided significant short-term weight loss to a patient population that was already enrolled in an established pharmacist-directed employee wellness program and had not shown clinical improvement prior to the intervention. Overall the patients were satisfied, felt healthier, and agreed to continue following the recommendations of the program.

 

Type: Original Research
Examining the Effect of a Medication Synchronization or an Education Program on Health Outcomes of Hypertensive Patients in a Community Pharmacy Setting
Authors: DiDonato Kristen L. , Vetter Kristin R. , Liu Yifei , May Justin R. , Hartwig D. Matthew
Published: January 2018

Objective: To examine the effect of a medication synchronization or education program on hypertensive health outcomes.

Methods: This study used a design of randomized controlled trial lasting four months taking place within a family-owned community pharmacy chain in a U.S. Midwestern state. A total of 302 hypertensive patients were randomized into 3 study groups - control, medication synchronization, and education. Interventions included management of medication refills through a medication synchronization program for the medication synchronization group, and monthly hypertension (HTN) education for the education group. Outcome measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), percentage of patients at blood pressure (BP) goal, self-rated change in medication adherence, and patients' HTN knowledge.

Results: All groups had significant decline of SBP from baseline; however the final analysis showed no significant SBP differences among study groups. The proportion of patients achieving BP goals in both the control (p=0.005) and education (p=0.019) groups increased at Month 4. Changes in self-reported adherence were not significant for any groups. All groups showed positive changes on HTN knowledge questions with the education group showing the greatest change.

Conclusion: Compared to the control group, there was no difference in the primary outcomes. However, this study demonstrated that educational materials written at an appropriate level and presented by community pharmacists to patients may have been associated with an increase in HTN knowledge and a significant increase in the proportion of patients achieving their BP goal. These educational interventions had a greater impact on helping patients achieve their blood pressure goals than medication synchronization. This may indicate that further intervention is needed to impact adherence aside from ensuring that patients have their medication on hand. Taking the time to educate patients about hypertension led to self-reported positive change with being more careful about taking medications and with not forgetting to take medications when they felt better.

 

Type: Original Research
Interview with the Medicine Man: A Case Study of a Traditional Malian Healer
Authors: Rovers John
Published: January 2018

Pharmacists are commonly members of medical mission teams that provide health care services in underdeveloped countries. Although pharmacists and others often find their service on a mission trip to be positive and life changing, critics of such missions note that Western providers trained in biomedicine frequently lack the cultural awareness to practice effectively in such settings. This paper is a case study of one traditional healer who practices in rural Mali. Although the results of one case from one practice setting may not be generalizable to all cultures, a basic understanding of the healer's beliefs and practices concerning the etiology and treatment of disease, the role of magic and other supernatural therapies, his experience with Western trained providers and the regulatory environment in which he works should assist pharmacists who serve on mission trips to be better culturally prepared.

 

Type: Case Study
Evaluation of an Initiative for Fostering Provider-Pharmacist Team Management of Hypertension in Communities
Authors: Doucette William R. , Lickteig Cailin , Veach Stevie , Carter Barry , Levy Barcey
Published: January 2018

Objectives: 1) Conduct team building activities for provider-community pharmacist teams in small communities and 2) Determine the impact of the team approach on practitioner-reported consequences and 3) Identify obstacles to the team approach and ways to overcome them.

Methods: Eleven provider-pharmacist teams were recruited in rural/micropolitan communities in Iowa. The teams participated in team building sessions facilitated by the project leaders, to discuss the team approach. Decisions included patient identification, practitioner roles, and communications. Most pharmacists conducted blood pressure (BP) checks in the pharmacy and assessed the anti-hypertensive medications. If the BP was not at goal, the pharmacist worked with the patient and provider to make improvements. Teams followed their strategies for 3-5 months. Data were collected from pharmacy logs and on-line surveys of team members before and after the team period.

Results: Using a multi-case approach, 4 cases were classified as Worked-Well, 5 as Limited-Success, and 2 as No-Team-Care. The Worked-Well teams provided an average of 26.5 BP visits per team, while the Limited-Success teams averaged 6.8 BP visits. The Worked-Well teams established and used a system to support the team approach. The Limited-Success teams either didn't fully establish their team system, or used it sparingly. The No-Team-Care cases did not provide any team care.

Conclusions: Factors supporting success were: positive provider-pharmacist relations, established team system, commitment to team care, and patient willingness to participate. While this program had some success, potential improvements were identified: more follow-up after the team building session, additional patient materials, and guidance for practice changes.

 

Type: Case Study
Student pharmacists' and recent graduates' perception of and interest in independent pharmacy ownership
Authors: Sweaney Ashley M. , Casper Kristin A , Hoyt Cara D. , Wehr Allison M.
Published: January 2018

Objectives: To assess student pharmacists' and recent graduates' interest in independent community pharmacy ownership and compare perceptions of pharmacy ownership among students and recent graduates.

Methods: An anonymous online survey was administered to student pharmacists currently licensed as interns and pharmacists licensed by examination from January 2010 to October 2012 within the state of Ohio.

Results: 355 surveys were completed during the study period, with 200 (56.3%) completed by student pharmacists. Student pharmacists were significantly more interested in pharmacy ownership (p < 0.001) and had significantly higher self-reported likelihood of ownership (p = 0.03) compared to recent graduates. Top ranked advantages to ownership for both groups included professional autonomy, development of innovative services, and amount of time spent in patient care activities. The majority of respondents had been exposed to pharmacy ownership within a course, student organization, or experiential rotation, but felt they needed more training in financial, legal, and regulatory issues.

Conclusion: Many student pharmacists and recent graduates are interested in pharmacy ownership. However, the majority of respondents feel it is unlikely they will own a pharmacy in the future. Resources need to be expanded for those interested in this career path.

 

Type: Original Research
Pharmacists' Roles and Factors Affecting Patient Care in Korea
Authors: Hwang Monica J. , Young Henry N.
Published: January 2018

Objectives: This study was conducted to explore Korean community pharmacists' perceptions of their roles in providing care to patients after the implementation of the Separation of Prescribing and Dispensing Act (SPD Act) and to investigate pharmacists' perceptions about factors that impact their patient care.

Methods: Eight community pharmacists participated in semi-structured, face-to-face, in-depth interviews in Korea. A snowball sampling technique was used to obtain participants. Interviews were audio-recorded and transcribed. Interviews were analyzed using a summative content analysis procedure.

Key findings: Participants' perceptions of their roles centered on dispensing prescriptions, educating and counseling patients, and helping patients with OTC products. Participants perceived time constraints due to prescription volume and patient expectations as factors influencing their provision of patient care.

Conclusion: This study suggests that the SPD Act was successful in changing pharmacists' roles in the Korean health care system. None of the participants perceived their role to include prescribing, while all of the participants indicated that their primary role was to dispense medications. Future research should examine the pervasiveness of the themes identified in this study across Korean community pharmacy practice in order to generalize the impact of the SPD Act.

 

Type: Original Research
Improving Blood Pressure Control in Over-the-Road Truck Drivers: Is Provision of Medication Therapy Management by Pharmacists Feasible?
Authors: Hager Keri D. , Aronson Benjamin D. , Smith Reid C. , Parra David , Swanoski Michael
Published: January 2018

Purpose This pilot sought to determine feasibility of studying the impact on hypertension in over-the-road truck drivers who met with pharmacists for Medication Therapy Management (MTM) compared to those who did not.

Design/methodology/approach Drivers were randomly assigned to control or treatment (MTM) group for 52 weeks. Drivers assigned to the MTM arm could receive services in person or via secure videoconferencing technology located in a private space at the trucking company. All subjects were provided education and received a blood pressure monitor and log for recording daily blood pressures.

Findings Eleven drivers enrolled and seven drivers completed the study. The primary barriers to participation included unpredictable driver schedules and lack of access to MTM provider while on the road.

Research limitations/implications This pilot study was limited by small sample size. Pharmacists were not available to meet with truckers "on demand." Therefore, researchers are encouraged to test alternate opportunities to increase enrollment of drivers in studies and access to MTM services while drivers are on the road.

Practical implications Hypertension is the second highest health-related cost burden, and over-the-road truck drivers have unique challenges that can make it difficult to attain blood pressure control. Pharmacist-provided MTM has been shown to improve blood pressure control. Improving access to MTM, perhaps using a national network of pharmacists or technology from the road, may decrease morbidity and mortality in drivers.

Originality/value This paper fulfills an identified need to study how to improve driver access to care to reduce cardiovascular-related morbidity and mortality.

 

Type: Clinical Experience