bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishing the Medication Safety Research Network of Indiana (Rx-SafeNet): Perspectives of Community Pharmacy Employees
Authors: Seel Lindsey V. , Hultgren Kyle E. , Snyder Margie E.
Published: January 2018

The objective of this cross-sectional survey was to determine community pharmacy employee research project priorities and assess interest levels, barriers, and facilitators to joining a new community pharmacy practice-based research network (PBRN) and use this information in subsequent PBRN development. One hundred forty pharmacists and 40 support staff responded. The majority (72%) of respondents were somewhat interested or needed more information to determine their level of interest in joining a PBRN; 15% were very interested. While all research topics were regarded as important, dispensing errors were rated as the most important. Time constraints were considered the greatest barrier to participation. Greater knowledge of medication safety, enrichment of patient care, and improved patient and provider relationships were considered important reasons for joining a PBRN. Responses indicated favorable interest levels and project support from potential network members, though education and awareness campaigns are needed to enhance community pharmacy employee understanding of and involvement in research and PBRNs, specifically the Medication Safety Research Network of Indiana (Rx-SafeNet), a new network administered by the Purdue University College of Pharmacy. While the generalizability of survey results is limited, they were useful in determining policies and procedures of the new network. Surveying all employees involved in the future PBRN during the network development process is a unique approach to developing these types of networks in the U.S. Understanding support staff perspectives is important considering the critical role they play in project implementation and operations. Emerging PBRNs from any discipline may benefit from considering adding this step to their development.

 

Type: Original Research
Withdrawing Drugs in the U.S. Versus Other Countries
Authors: Ninan Benson , Wertheimer Albert I
Published: January 2018

Since 1979, the United Nations has maintained a list of drugs banned from sale in member countries. Interestingly, there are a number of pharmaceuticals on the market in the USA that have been banned elsewhere and similarly, there are some drug products that have been banned in the United States, but remain on the market in other countries. This report provides a look into the policies for banning drug sales internationally and the role of the United Nations in maintaining the master list for companies and countries to use for local decision guidance.

 

Type: Commentary
Using Think Aloud Protocols to Assess E-Prescribing in Community Pharmacies
Authors: Odukoya Olufunmilola K. , Chui Michelle A.
Published: January 2018

Introduction: Think aloud protocol has rarely been used as a method of data collection in community pharmacies.

Purpose: The aim of the report is to describe how think aloud protocols were used to identify issues that arise when using e-prescribing technology in pharmacies. In this paper, we report on the benefits and challenges of using think aloud protocols in pharmacies to examine the use of e-prescribing systems.

Methods: Sixteen pharmacists and pharmacy technicians were recruited from seven community pharmacies in Wisconsin. Data were collected using direct observation alongside think aloud protocol. Direct observations and think aloud protocols took place between January-February, 2011. Participants were asked to verbalize their thoughts as they process electronic prescriptions.

Results: Participants identified weaknesses in e-prescribing that they had previously not conceived. This created heightened awareness for vigilance when processing e-prescriptions. The main challenge with using think aloud protocols was due to interruptions in the pharmacies. Also, a few participants found it challenging to remember to continue verbalizing their thought process during think aloud sessions.

Conclusion: The use of think aloud protocols as method of data collection is a new way for understanding the issues related to technology use in community pharmacy practice. Think aloud protocol was beneficial in providing objective information on e-prescribing use not solely based on pharmacist's or technician's opinion of the technology. This method provided detailed information on a wide variety of real time challenges with e-prescribing technology use in community pharmacies. Using this data collection method can help identify potential patient safety issues when using e-prescribing and suggestions for redesign.

 

Type: Note
Health-Related Quality of Life Impact in Employees Participating in a Pharmacist-Run Risk Reduction Program
Authors: Lenz Thomas L. , Gillespie Nicole D. , Skrabal Maryann Z. , Faulkner Michele A. , Skradski Jessica J. , Qi Yongyue , Coleman Abby W.
Published: January 2018

Health related quality of life (HRQOL) and self-perceived well-being have been shown to be associated with lower healthcare utilization and costs in people with chronic diseases. A pharmacist-run employee health program started in 2008 sought to improve HRQOL through the use of individualized lifestyle behavior programming, medication therapy management, and care coordination activities. Following one year of participation in the program, employee participant's self-reported general health rating significantly improved compared with their baseline rating (p < 0.001). Participants also reported a significantly lower number of days within a month when they did not feel physically and/or mentally well at baseline vs. one-year, respectively (10.3 days vs. 6.0 days, p < 0.01). Pharmacists can positively impact self-reported HRQOL when working in an employee health setting.

 

Type: Original Research
Effective Modification of a Nonprescription Medicines Course to Optimize Learning of Millennial Generation Students
Authors: Mehta Bella H , Casper Kristin A
Published: January 2018

Objective: To describe examples of effective teaching strategies utilized within a required nonprescription therapeutics course, in order to accommodate learning characteristics of Millennials.

Case Study: Instructors identified unique characteristics of Millennial generation students through literature review and focused educational workshops. These characteristics include the desire for active learning where didactic lectures make a connection to life, the incorporation of technology, and assignments that focus on team work. Course modifications were then made based on these characteristics including redesign of large group course lectures with incorporation of patient cases, inclusion of a variety of online components including the opportunity to provide course feedback, and active learning small group projects within workshop sections.

Evaluation:Student evaluation of the course and instructors significantly improved after introducing changes to the course compared to previous years. Each component of the student evaluation resulted in a statistically significant change in mean score. Verbal and written evaluations indicated a very positive learning experience for students. Grade mean (3.3 vs. 3.8, p

Conclusions: By identifying characteristics of Millennial generation student learners, traditional teaching methods can be modified in order to enhance retention of material and optimize their learning process. Course changes improved the learning experience for students and instructors. Instructors' willingness to evaluate generational differences and adapt teaching enhances the learning experiences in the classroom for both students and instructors.

 

Type: Case Study
Effects of Medication Reconciliation Service Provided by Student Pharmacists in a Tertiary Care Emergency Department
Authors: Okere Arinzechukwu Nkemdirim , Gessert Charles , Renier Colleen , Swanoski Michael
Published: January 2018

Objective: The primary objective of this case study was to evaluate the impact of a medication reconciliation service (MRS) provided by student pharmacists in an emergency department (ED).

Methods: Eligible patients were assigned to two groups, MRS or non-MRS. Patients in the MRS group were seen by student pharmacists while the non-MRS group followed usual care. As part of the services provided by the student pharmacists, medication reconciliation was provided under the supervision of a clinical pharmacist. At the conclusion of their ED visit, patients were asked to complete a survey addressing knowledge of medications, confidence in medication taking and patient satisfaction. To evaluate the impact of provision of MRS by student pharmacists on readmission rates in the ED, the electronic health records of the institution were queried for subsequent inpatient hospitalizations and ED visits.

Results: Based on the study, patients in MRS group were more likely to be satisfied with the education provided to them in the ED (p=0.016) and had greater confidence in taking their medications (p=0.03). Sixty days post ED visit MRS group readmissions were significantly lower compared to non-MRS group (P= 0.047).

Conclusions: Students' participation in the provision of medication reconciliation led to reduction of readmission in the tertiary care ED, improved patient satisfaction and confidence in medication use.

 

Type: Case Study
An Elective Course in Women's Health Issues
Authors: DiPietro Natalie A.
Published: January 2018

Purpose: To develop, implement, and evaluate an elective course for the Doctor of Pharmacy (PharmD) curriculum that provides students with a comprehensive overview of women's health across the lifespan and exposes them to social and economic issues that impact women's health.

Case Study: At the time of this writing, the class has been delivered 3 times to a total of 56 students. Students read and discussed (both in-class and online) timely articles in women's health issues on topics including sex-based biology; women in clinical trials; maternal and child health; women's health coverage and access to care in the United States; gender and health communication; abuse and the role of healthcare professionals; and international issues in women's health and women's rights. Students completed a pre- and post-test; developed seminar presentations regarding women's health issues; wrote reflective essays about the course; and designed and implemented health promotion projects for National Women's Health Week (NWHW). At the end of the course, the number of correct answers on the post-test significantly improved from the pre-test (p<0.001). Through anonymous course evaluations, students indicated that the assignments fulfilled the learning objectives (mean 4.68 on a 5-point Likert scale) and the exercises were useful in helping their understanding of the material (mean 4.66 on a 5-point Likert scale). Over 500 women from the campus and community participated in the NWHW projects.

Implications: An elective course was designed to educate pharmacy students regarding women's health issues and to provide students with an opportunity to perform community outreach.

 

Type: Case Study
Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management
Authors: Lamb Michelle M. , Wu Weiwei , Lloyd Ann
Published: January 2018

The current drug shortage crisis involving multiple oral antibiotics has significantly impacted preferred therapeutic options for treatment of H.pylori infection. Pharmacists may help alleviate the impact of this shortage through a proposed step-wise approach which includes proper inventory management, verification of indication, evaluation of regimen, therapeutic monitoring, and communication with patients and providers regarding alternative therapy or symptomatic relief.

 

Type: Original Research
Leadership: Three Key Employee-Centered Elements with Case Studies - Editor's Commentary
Authors: Sorensen Todd
Published: January 2018

Type: Commentary
Design and Implementation of Acute Emergency Decision Making Tools to Aid Case Managers: A Focus Group Study
Authors: Bradshaw Marquita D. , Washington Nicole B. , Munoz Ricky , Brahm Nancy C.
Published: January 2018

Objectives: To evaluate and determine if use of specific reference cards for diabetes, stroke, and heat stroke [1] heightened understanding of the signs and symptoms of these conditions and [2] helped case managers (CMs) on the community-based integrated multidisciplinary program of assertive community treatment (IMPACT) team better evaluate patients.

Background: Healthcare professionals who service those with a severe mental illness (SMI) diagnosis face many unique challenges. One particular challenge is medical assessment of patients with a SMI diagnosis. Often CMs do not have a background or work experience differentiating medical concerns from psychiatric signs and symptoms.

Methods: Reference cards were developed at the request of the IMPACT team. Feedback was elicited through a one-time focus group session conducted by an independent party on the use of the reference cards as an educational tool. Anonymity was maintained. The responses were evaluated for themes. The moderator asked questions regarding the reference cards in each of the following areas: usability when answering questions about hypo- and hyperglycemia, stroke and heat stroke, understanding key points, recommendations for enhancement, and presentation of information.

Results: Of the 8 CMs on the IMPACT team, 5 participated. Identified themes were quick reference and easily identifiable information. The use of pictures to illustrate the concepts was helpful. The language was appropriate for the cards and readily understandable. Suggestions for changes to the existing cards included use of a larger font, lighter background color, and moving medication information to the same side of the card. The limited availability of the heat stroke card in the summer was an identified limitation.

Conclusions: The use of reference cards as an educational tool for CMs has not been extensively reviewed. Although data are limited from this pilot project, the CMs are enthusiastic about this resource and requested cards on additional topics.

 

Type: Original Research
Value of Online Medication Therapy Management Resources: Community Pharmacist Perspectives
Authors: Doucette William R. , Nguyen Elaine , Zhang Yiran , Pendergast Jane F. , Chrischilles Elizabeth A. , Farris Karen B. , Frank Jessica
Published: January 2018

Objectives: To describe pharmacists' attitudes toward and satisfaction with on-line training modules on MTM tools and tips for pharmacists and to characterize how useful the tools and concepts in the modules were to pharmacists when delivering MTM services.

Methods: Researchers distributed a web-based survey to pharmacists who had viewed the training modules that had been posted onto the training web site of OutcomesMTM. The majority of survey questions consisted of a 6-point Likert scale. Questions assessed pharmacists' opinions on the use of the tools. Information also was collected on implementing MTM tips, pharmacist demographics, and practice site characteristics.

Results: Respondents rated the Tool to Improve Medications in the Elderly via Review (TIMER) and DRug Adherence Work-up (DRAW) tools favorably across multiple items. Many pharmacists integrated the MTM tips into their practices, and reported increased efficiency in their delivery of MTM services.

Conclusion: Pharmacist training and tools such as the TIMER and DRAW tools plus MTM practice tips can assist pharmacists in providing MTM services to patients.

 

Type: Original Research
Medication non-adherence in the homeless population in an Intermountain West city
Authors: Unni Elizabeth J. , Ashment Riki , Miller Elizabeth , Draper Andrew M.
Published: January 2018

Background: Homelessness happens when people or household are unable to acquire and/or maintain housing they can afford. Approximately 17% of homeless individuals are also chronically ill. Studies have often not objectively measured medication non- adherence among the homeless population, probably due to lack of consistent pharmacy records. This study proposed to objectively estimate medication non-adherence to chronic medications among the homeless population in Salt Lake City, Utah.

Methods: A retrospective study design was used based on the pharmacy records from the Fourth Street Pharmacy based on four classes of chronic medications - asthma, diabetes, statins, and psychiatric medications. Data was collected between November 1, 2010 and February 28, 2011 on the variables: date of original prescription, number of refills on the original prescription, date of 1st, 2nd, 3rd, and 4th fills, age, gender, and race. Primary non-adherence and medication refill non-adherence based on Continuous Measure of Medication Gaps were calculated.

Results: The medication refill non-adherence rate was 38.8% with asthma medications, 38.5% with diabetic medications, 27.2% with statins, and 47.1% with psychiatric medications. The primary non-adherence rate varied from zero percent to 20%.

Conclusion: The study concluded that this population has comparable non-adherence rates with asthma, diabetes, cholesterol lowering, and certain psychiatric medications than the general population.

 

Type: Original Research
How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration
Authors: Hahn Lindsay , Buckner Martha , Burns Georgeann B. , Gregory Debbie
Published: January 2018

Purpose: The Pharmacy Practice Model Initiative (PPMI) calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support.

Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital's pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy's influence on a hospital's bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI.

Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together - and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families.

 

Type: Commentary
Evaluation of provider documentation of medication management in a Patient-Centered Medical Home (PCMH)
Authors: Nguyen Trang T. , Mehta Bella H. , Rodis Jennifer L. , Casper Kristin A , Wexler Randell K.
Published: January 2018

Purpose: The National Committee for Quality Assurance (NCQA) has standards for recognizing Patient-Centered Medical Homes (PCMH) including one for medication management. Study objectives were to identify if and how providers within a PCMH recognized under the 2008 guidelines were documenting components of medication management to meet NCQA's 2011 requirements including: 1) providing information about new prescriptions to >80% of patients; 2) assessing understanding of medications for >50% of patients; and 3) assessing response and barriers to medication adherence for >50% of patients.

Methods: Physician and pharmacist-led patient visits from a family medicine office, from February 1 to August 1, 2012 were assessed. Patients over 18 years old taking at least one medication were included. A retrospective chart review was performed to assess documented components of medication management. Descriptive statistics were used to analyze data.

Results: A systematic sampling of 450 physician-led and 195 pharmacist-led patient visits, demonstrated providers did not meet documentation goals for providing patients information on new prescriptions (65% pharmacist, 24% physician, 36% of total provider notes) or for assessment of patients' understanding of medications (9% pharmacist 12% physician, 11% of total provider notes). Individually each type of provider did not meet the goal of assessing patient response and barriers to adherence to medication, but with combined intervention by the pharmacists and the physicians, the site was able to surpass NCQA's percentage goal (57% and 58%).

Conclusions: No components of medication management are well documented. Using the electronic medical record, pharmacists may be able to develop documentation tools and assist sites to meet NCQA's goals for medication management.

 

Type: Original Research
Validity of Electronic Prescription Claims Records: A Comparison of Commercial Insurance Claims with Pharmacy Provider Derived Records
Authors: Martin Bradley C. , Shewale Anand
Published: January 2018

Objectives: To determine if and to what extent records obtained from PBM pharmacy claims differ from source documents obtained directly from pharmacy providers. This study also sought to explore possible associations between patient, pharmacy benefits, and pharmacy provider characteristics and the likelihood a patient would have missing prescription claims.

Methods: This study used a cross-sectional design which included a sample of 1,484 patients residing in a single state with a common pharmacy benefit. Profiles describing all prescriptions filled in a pharmacy between January 1, 2002 through June 30, 2002 of these patients were requested directly from their pharmacy providers. Logistic regression was used to explore the factors associated with a person receiving a prescription that did not appear on the PBM claims.

Results: Of the 1,484 eligible recipients sampled, profiles were obtained for 323 (22%) persons and there were analyzable profiles for 315 (21%) persons. There were a total of 2,977 prescriptions filled for the 315 subjects. Of those 2,977 prescriptions, 207 (7.0%) were missing from the claims files indicating that 93% were captured. Only prescription volume consistently influenced the likelihood a patient would have a missing prescription from the PBM claims (OR =1.08; 95%CI:1.05-1.12).

Conclusion: Claims obtained from pharmacy benefit companies capture approximately 93% of prescription records when verified with records obtained from pharmacy providers. The rate of missing records from PBM claims does not appear to be meaningfully influenced by most finance based pharmacy benefit design features. However, certain classes of drugs such as iron products, digoxins, diuretics, sulfonylureas, and antigout may have incomplete claims records compared to other classes of drugs. Higher prescription utilizers are more likely to have prescription records filled that are not captured by PBMs. These conclusions should be interpreted in light of the modest usable response rate from pharmacy providers of 22% and the unknown generalizability of these patients utilizing one particular PBM from 2002 in the state of Georgia.

 

Type: Original Research
Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students
Authors: Skelley Jessica W. , Carpenter Chase , Elkins Trisha , Woolley Thomas W. , Dugan B. DeeAnn
Published: January 2018

Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP) during their Advanced Pharmacy Practice Experience (APPE) in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP's and used for this purpose with participating students on their ambulatory care APPE.

Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18) at the start of their ambulatory care APPE. The test was designed to assess both the students' baseline knowledge regarding MRP's, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest) to complete to assess if their knowledge had increased from baseline.

Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP's. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students' knowledge or ability to properly identify and classify medication related problems (MRP) after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884). However, a statistically significant decline in students' knowledge occurred on one specific question, which tested their ability to classify MRP's (p = 0.029).

Conclusions: Based on the results of the pre-test, students at our institution enter their APPE year with limited baseline knowledge of medication safety within the ambulatory care setting. Results from the posttest indicate potential ineffectiveness of a written document in providing effective education on MRP's to students in the experiential setting. Education may be made more effective with a hands-on, active learning approach that overcomes the limitations of other passive forms of learning.

 

Type: Student Project
Incentivizing Antibiotic Research and Development
Authors: Scandlen-Finken Leah , Wertheimer Albert
Published: January 2018

Antibiotic Resistance is an international threat, killing thousands and infecting millions. Although certain populations may be at an increased risk for infections, anyone can find themselves compromised with a multi-drug resistant infection. Treatments are becoming more complicated as the bacteria becomes more elusive. Cures are becoming less certain, and the future antibiotic arsenal is looking thin. Although there are many talented scientists and capable drug development entities, the funding and returns on investment are not sufficient to entice antibiotic research and development.

This paper explores the current situation regarding antibiotic resistance and its casualties, as well as the mechanisms being employed to overcome the increase in resistance, and decrease in antibiotic effectiveness. Through analysis of antibiotic research, development, and regulation, this paper adds to the discussion by filling in the current gaps regarding the procurement of sustainable funding via an insurance model framework. By incentivizing the pharmaceutical industry to invest in antibiotic research, and by guaranteeing returns on investment, a global solution to the current antibiotic resistance problem can be contained.

 

Type: Student Project
Exploring Accessibility of Community Pharmacy Services
Authors: Kelling Sarah E.
Published: January 2018

Objective: To use selected literature to describe strengths and opportunities for improvement related to accessibility of health services in the community pharmacy setting.

Summary: Pharmacists have been described as one of the most accessible health care professionals, particularly as nearly 90% of Americans live within 5 miles of a community pharmacy. However, geography alone does not provide access to health services. Individuals must be able to gain entry into the health care system, access a health care location where needed services are provided, and find a health care provider with whom the patient can communicate and trust. Current and potential opportunities for community pharmacists to increase access via each step are described.

Conclusion: Community pharmacists are highly accessible health care professionals who are trusted by patients. Opportunities exist to further increase access to dispensing and non-dispensing services in order to better meet the needs of the public.

 

Type: Commentary
Criteria-based Certification and Validation of Online Pharmacies: Opportunities for Improved Quality and Safety
Authors: Ersin Özlem H. , Naistat David M.
Published: January 2018

Objectives: The objective of this study was to explore the conformity of online sites with established quality standards.

Methods: Online pharmacies with the NABP Verified Internet Pharmacy Practice Sites (VIPPS) designation were scrutinized for their conformity with select criteria established by the National Association of Board of Pharmacies (NABP) and FDA consumer guidelines.

Results: 36 VIPPS certified online pharmacy sites were included in the study. The sites were examined against VIPPS and FDA standards. The criteria related to the design and content of the web site and to the pharmaceutical services being offered through the site. Lack of clear terminological distinction between “online pharmacy” (a business) and “online site” (a tool for a business) was problematic. Sites did not adhere to uniform design principles. The scope and availability of pharmaceutical services for online consumers were not readily apparent.

Conclusion: The very legitimacy of existing criteria for online pharmacies remains to be established. Significant opportunities exist to improve the quality and scope of policies and to tie them more closely to longstanding best-practices in areas such as web usability and pharmaceutical care. Revision recommendations for VIPPS criteria are discussed.

 

Type: Original Research
Health Literacy Based Communication by Illinois Pharmacists
Authors: Devraj Radhika , Gupchup Gireesh V.
Published: January 2018

Objectives: Health literacy has received attention as an important issue for pharmacists to consider when interacting with patients. Yet, there is little information about methods pharmacists use to communicate with patients and their extent of use of health literacy based interventions during patient interactions. The purpose of this study was to examine methods of communication and types of health literacy based interventions that practicing pharmacists use in Illinois.

Methods: A survey instrument addressing the study purpose was designed along with other items that were part of a larger study. Eleven items in the survey referred to pharmacist-patient communication. The instrument was pilot tested before administering to a random sample of 1457 pharmacists from the Illinois Pharmacists Association. Data were primarily collected via a mailed survey using Dillman’s five step total design method (TDM). Two reminder letters were mailed at two week intervals to non-respondents.

Results: Usable responses were obtained from 701 respondents (48.1% response rate). Using simple words (96%) and asking patients open-ended questions to determine comprehension (85%) were the most frequent methods that pharmacists used to communicate with patients. Only 18% of respondents always asked patients to repeat medication instructions to confirm understanding. The various recommended types of health literacy interventions were “always” performed by only 8 to 33% of the respondents. More than 50% of respondents indicated that they rarely or never had access to an interpreter (51%), or employed bilingual pharmacists (59%). Only 11% of pharmacists said that they rarely/never pay attention to nonverbal cues that may suggest low health literacy.

Conclusions: Pharmacists infrequently use action oriented health literacy interventions such as using visual aids, having interpreter access, medication calendars, etc. Additional training on health literacy, its scope, and related interventions coupled with system redesign and compensation for time spent counseling are essential to encourage health literacy tailored communication with patients.

 

Type: Original Research
Identifying Community Pharmacists' Readiness to Participate in Transitions of Care
Authors: Gibson Nicole , Kebodeaux Clark , Smith Daron , Holtgrave Kellye , Gattas Nicole
Published: January 2018

Objective: To determine the readiness of community pharmacists to participate in transitions of care and to identify barriers related to participation.

Methods: A questionnaire was developed to identify community pharmacists’ willingness, attitudes, and barriers to participating in transitions of care programs. The questionnaire was piloted with community pharmacists prior to implementation. The questionnaire was distributed to a population of chain, supermarket/grocery, and independent community pharmacists (n=200). Descriptive statistics, correlations, and chi square tests were used to analyze demographic trends and final results.

Results: Of the 200 questionnaires distributed, 147 pharmacists responded (73.5%). Community pharmacists agreed transitions of care services have the potential to improve patients’ understanding of medications (97.3%), decrease medication-related errors (95.9%), and enhance relationships with patients (96.6%). The largest pharmacist perceived barriers included time (69.7%), communication/lack of patient data (14.6%), and lack of physician acceptance (6.7%). Of the respondents who indicated time as the greatest barrier to participation, 76.9% of pharmacists were still willing to participate in transitions of care given the opportunity. Willingness to participate in transitions of care did not differ by gender (p=0.139), years in practice (p=0.133), or degree of education (p=0.382).

Conclusion: Community pharmacists are in a unique position to widely impact patient health outcomes and decrease hospital readmission rates through improved care coordination. This research demonstrates community pharmacists’ readiness and willingness to participate in transitions of care. Awareness of perceived barriers can allow stakeholders to address these areas when designing and implementing transitions of care programs with pharmacists.

 

Type: Original Research
Efficacy and Satisfaction of a Smoking Cessation Telephone Counseling Service Provided by Pharmacy Students
Authors: Soong Jie Lin , Wilken Lori
Published: January 2018

Objective: This was a prospective, research survey assessing patient satisfaction and efficacy of the smoking cessation telephone counseling service provided by pharmacy students at the University of Illinois Hospital.

Methods: From September 2012 through May 2013, 82 patients received telephone counseling post hospital discharge and were followed up at 30 days for a telephone survey. Primary outcomes included improvement in stages of change, motivation and confidence levels in quitting tobacco, as well as patient satisfaction of the service. Secondary outcomes included self-reported continuous and point prevalence abstinence rates at 30 days.

Results: Eighteen patients completed the survey. There was no significant difference before and after the service with regards to the stage of change (p = 0.14), motivation levels (p = 0.80) nor confidence levels (p = 0.89) to quit tobacco. Majority of patients felt the duration of the call was just nice (83.3%), but having only one call was too little (77.8%). Overall satisfaction of the service was 83.1%. Self-reported continuous and point prevalence abstinence rates at 30 days were 16.7% and 22.2%, respectively.

Conclusion: Although there was no statistically significant improvement in the stages of change, motivation and confidence levels to quit smoking, patients were highly satisfied with the telephone counseling service provided by pharmacy students.

 

Type: Clinical Experience
Transitions of Care Operations at a Family Medicine Clinic: Patient Follow Up and Financial Outcome Analysis
Authors: Thomas Ashley , Skelley Jessica , Wheeler Julie , Gonzalez English
Published: January 2018

Introduction: Coordinating smooth patient transitions remains a growing area of interest among healthcare professionals in light of the addition of the Readmission Reductions Program to the Affordable Care Act, which enables CMS to penalize hospitals for 30-day readmissions due to myocardial infarction, pneumonia, heart failure, and in due time, COPD. 2 Many facilities have tested varying TOC models previously piloted at other institutions, focusing on ensuring the proper measures are in place before patients depart. However, there is a significant lack in data quantifying the rate of timely patient follow up after discharge, despite the evidence supporting the value of this visit. The purpose of this study is to analyze TOC outcomes at a local family medicine clinic to assess potential lack of billing utilization and gaps of care related to patient follow up.

Methods: The investigators were provided with emergency department discharge charts from the local hospital affiliated with the family medicine clinic; discharge dates ranged from April 2014 to August 2014. Discharge charts were analyzed to establish medical complexity. Investigators used electronic medical records to extract descriptive data to analyze patient and financial outcomes. A subgroup analysis was performed utilizing a subset of patients identified as “established” at the clinic.

Results: A total of 317 unique discharge reports were evaluated, with 104 of those in the “established” patient subgroup. During the study period, 8.8% of the total group of patients demonstrated timely follow-up. Additionally, rate of incorrect billing techniques was 79%. A consequence of the low percentage of patient follow up and improper billing is missed revenue opportunity for the clinic; financial consequences range from $3,248.60-$67,150 over the 5 month period.

Conclusion: A coordinated outpatient TOC procedure cannot be determined from this study. However, need for further analysis of outcomes at outpatient facilities has been identified.

 

Type: Original Research
An Innovative Approach to Pharmacy Law Education Utilizing a Mock Board of Pharmacy Meeting
Authors: Bess D. Todd , Taylor Jade , Schwab Carol A , Wang Junling , Carter Jason A
Published: January 2018

A thorough understanding of pharmacy law by students is important in the molding of future pharmacy practitioners, but a standardized template for the best way to educate students in this area has not been created. A mock Board of Pharmacy meeting was designed and incorporated into the Pharmacy Law course at the University of Tennessee College of Pharmacy. Students acted as Board of Pharmacy members and utilized technology to decide outcomes of cases and requests addressed in a typical 2 day Tennessee Board of Pharmacy meeting. The actual responses to those cases, as well as similar cases and requests addressed over a 5 year period, were revealed to students after they made motions on mock scenarios. The mock Board of Pharmacy meeting engages the students in a way that lectures alone often fail to achieve with some initial evidence of successful student learning. Utilizing this teaching format as a law education tool challenges the status quo of pharmacy education and may serve as an impetus and catalyst for future innovations.

Conflict of Interest

We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents, and royalties. Dr. Wang’s time was partly supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG040146 and R01AG049696. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

 

Type: Idea Paper
From Drug Literature Evaluation to Evidence-Based Medicine: Transforming the Focus of a First Year Pharmacy Curriculum
Authors: Reidt Shannon , Hager Keri , Beattie James , Pittenger Amy , Smith Maureen , Janke Kristin
Published: January 2018

This case study describes a longitudinal curricular sequence implemented to teach evidence-based medicine (EBM) skills. The longitudinal sequence is innovative in its approach, design, and assessment of EBM. This approach moves away from the conventional strategy of teaching drug information and drug literature evaluation as stand-alone courses and instead embraces the EBM Framework and its use in the context of authentic problem solving. The EBM Framework—Ask, Acquire, Appraise, and Apply—was used as the basis for defining seven EBM skills. These skills were targeted in the evidence-based, integrated design of 17 learning episodes delivered with eight faculty members through six courses in the first year. Student perceptions of relevance of EBM and performance on assessments and learning activities throughout the sequence suggest that integrating EBM across the first year of the curriculum is an effective strategy for teaching EBM skills. Three themes emerged from analysis of the data and experience, including the need for: a strong teaching team, a whole task approach with a focus on solving authentic problems, and care in interpreting the progression of assessments and patterns of student performance. Through instructor observations and peer review, the longitudinal sequence has been refined and has had an impact on the rest of the curriculum.

 

Type: Case Study
Four Themes to Enhanced Interprofessional Education Integration: Lessons Learned from Early Implementation and Curricular Redesign
Authors: De Voest Margaret , Meny Lisa , VanLangen Kali , DeVuyst-Miller Susan , Salvati Lisa , Bright David , Elder Jodie , Vava Kari
Published: January 2018

With the release of the Accreditation Council for Pharmacy Education (ACPE) Standards 2016, interprofessional education (IPE) has become more formalized and needs to be embedded into the curricula of colleges and schools of pharmacy. While IPE is not new to the practice and training of pharmacists, the call for IPE has become more robust over the last several years creating challenges to widespread implementation. The purpose of this Case Study Report is to describe a twelve-year progression of IPE implementation at a college of pharmacy without an academic medical center. Focused strategies for the development, integration, and expansion of IPE are provided through the context of four themes: working through program differences; collaborators and effective collaboration; attention to implementation planning; and prebriefing and debriefing. Each theme is defined and reviewed using specific examples and lessons learned. Finally, in consideration of the ACPE Standards 2016, potential next steps are discussed.

 

Type: Case Study
Modeling Imaginary Worlds: Version 4 of the AMCP Format for Formulary Submissions
Authors: Langley Paul C
Published: January 2018

The question of demarcation between normal science and pseudoscience is critical to the discovery of new facts. The core elements supporting progress in science are: (i) empirically evaluable coherent theories and (ii) the testing of hypotheses through experimentation or systematic observation. If modeled or simulation-based claims for cost-effectiveness are to be accepted as a credible input to health care decision making than they must conform to these standards. Claims should be testable, falsifiable and replicable. If not then they are best seen as pseudoscience. This assessment of the latest version of the Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions (Version 4.0; April 2016) concludes that, in their recommendations for cost-effectiveness modeling, the proposed standards do not meet those of normal science. Rather, in common with previous versions of the AMCP Format, the modeling framework proposed not only puts to one side the issue of testable claims, but supports the modeling of imaginary worlds or thought experiments where claims are immune to falsification. In consequence, the payer or other recipient of a modeled or simulated claim that follows the AMCP Format has no idea, in the absence of observation or experimentation, whether the claim is right or even if it is wrong. The claims are potentially misleading, possibly harmful, but to an unknown extent. They have no place in evidence-based medicine.

Conflict of Interest

None

Type: Commentary
Cost-Effectiveness and Formulary Evaluation: Imaginary Worlds and Entresto Claims in Heart Failure
Authors: Langley Paul C
Published: January 2018

The Program in Social and Administrative Pharmacy at the University of Minnesota recently released its proposed guidelines for formulary evaluation. The guidelines were focused on ensuring that comparative claims made for pharmaceutical products and devices rested on a credible evidence base. The argument was put forward that if value claims for clinical and cost-effectiveness outcomes were to be accepted then they had to be empirically evaluable. The purpose of this commentary is to explore alternative modeled claims for Entresto, an angiotensin receptor neprilysin inhibitor, versus the standard of care with an ACE inhibitor in patients with chronic heart failure. Two models are compared: a lifetime cost-per-QALY model and a 3-year cost and budget impact model. The primary reason for this comparison is the puzzling feature that for a product which is over 120 time as expensive compared to the standard of care (Entresto $380 per month vs. ACE inhibitor $3 per month) the modeled claim can be made that the product is, in willingness to pay terms, cost-effective. The analysis illustrates that, perhaps not surprisingly, different models can generate quite different perspectives on the presumption of ‘cost-effectiveness’. In the present case the simple decision model yields a breakeven monthly cost for Entresto of only $23.74. If modeled claims are to be useful for formulary decision making, then we need to eschew ‘black box’ models with non-evaluable claims in favor of those models that yield credible, evaluable and replicable claims that can support defensible product placement and pricing decisions.

Conflict of Interest

None

 

Type: Commentary