bluuebunny/crossref_metadata_2025_split huggingface dataset:
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
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
Method validation in pharmaceutical analysis: from theory to practical optimization
Authors: Eserian Jaqueline Kaleian , Lombardo Márcia 
Published: January 2018

The validation of analytical methods is required to obtain high-quality data. For the pharmaceutical industry, method validation is crucial to ensure the product quality as regards both therapeutic efficacy and patient safety. The most critical step in validating a method is to establish a protocol containing well-defined procedures and criteria. A well planned and organized protocol, such as the one proposed in this paper, results in a rapid and concise method validation procedure for quantitative high performance liquid chromatography (HPLC) analysis.

Type: Commentary
Evaluation of Medication Kit Processing Time Using Radio Frequency Identification (RFID) Technology
Authors: Summerfield Marc R. , Xiao Yan 
Published: January 2018

A study was conducted to evaluate the time devoted to medication kit processing using radio frequency identification (RFID) technology versus traditional processing. The article reviews the traditional, non-automated process as well as the automated RFIDbased process. The comparative methodology is reviewed, including limitations. The result shows a statistically significant time savings with the RFID-based technology in both process components (restocking and verifying) and the total. Other elements important in institution decision-making are reviewed.

Type: Original Research
An Advanced Registered Nurse Practitioner-Community Pharmacist Team-Based Approach to Managing Hypertension in a Rural Community Pharmacy
Authors: Parker Christopher P. , Kelchen Sherry L. , Doucette William R. 
Published: January 2018

Purpose: To evaluate the implementation of an Advanced Registered Nurse Practitioner (ARNP) – community pharmacist team-based collaborative model for managing hypertension in a rural, Midwestern, community pharmacy and family medicine clinic using the core functions of the patient centered medical home model (PCMH).
Methods: Thirteen patients with uncontrolled hypertension, 5 of who were newly diagnosed, were referred to the pharmacist by the ARNP. The pharmacist rechecked the patient’s blood pressure (BP) every 2 weeks after referral and made drug therapy change recommendations to the ARNP if the patient was not below goal.
Results: Following the intervention, the average SBP and DBP decreased 24 mmHg and 12mmHg, respectively. The pharmacists made 21 recommendations (dose increase (11), add a medication (6), change a medication (2), and addition of an adherence tool (2)), 100% of which were accepted by the ARNP.
Conclusion: A team-based approach to managing hypertension in a rural community pharmacy and family medicine clinic was an effective way to lower blood pressure. In addition, the core functions of the PCMH model can be delivered in a small family medicine practice. Creating specific expectations for each member of the team prior to referring patients improved the efficiency of the intervention.

Type: Original Research