bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Roles of Community Pharmacists in Managing Patients with Diabetes: Perceptions of Health Care Professionals in Nova Scotia
Authors: Hartnell Nicole R. , MacKinnon Neil J. , Sketris Ingrid S. , Gass David 
Published: June 2013

Background: Community pharmacists could reduce the clinical and economic burden of diabetes by participating in diabetes management. Pharmacists' roles in collaboration with other health care professionals should be understood before any community pharmacy—based programs focusing on diabetes management are designed and implemented. Methods: A sample of primary health care physicians, community pharmacists, and nurses and dieticians from Diabetes Centres in the Capital Health District of Nova Scotia were interviewed on their perceptions of community pharmacists' role in diabetes care. A semistructured format was used. Data were compiled and analyzed descriptively, and are reported here in terms of the roles of community pharmacists in this setting. Results: A total of 18 health care professionals were interviewed: 8 (44%) primary health care physicians, 6 (33%) community pharmacists, and 4 (22%) nurses and dieticians. All responses were analyzed, and six general roles for community pharmacists were identified, such as education about drug therapy (83% of respondents), followed by providing information to patients about glucose monitoring and healthy lifestyles (67% of respondents). Conclusion: In a pilot project ( n = 18), Nova Scotia health care professionals supported pharmacists' role in diabetic care, such as educating patients about drug therapy.
The Truer Picture of the Continuing Education Preferences of NL Pharmacists: Can We Apply What We Learned to Managing Diseases Such as HIV?
Authors: Mugford Gerry 
Published: June 2013

Background: The treatment of HIV disease is made more complex by rapid changes in disease management. Two primary objectives of this study were to evaluate the continuing education (CE) needs and preferences of pharmacists and to utilize this information to develop CE HIV disease management strategies. Our hypothesis was that current knowledge of HIV disease management is outdated and that CE related to HIV should be delivered in ways that meet the preferences of pharmacists. Methods: A 14-page needs assessment (NA) was developed to assess the CE needs and preferences of Newfoundland and Labrador (NL) pharmacists and their knowledge of HIV disease management. The NA was validated by pharmacists, physicians, nurses, and social workers from Memorial University of Newfoundland and the Health Care Corporation of St. John's. Respondents' answers were scored using a six-point Likert scale. Space was available for respondents to provide open answers and opinions related to the questionnaire, CE, and HIV. Piloting and feedback suggested the NA could be completed in 20–30 minutes. The NA was mailed to 470 pharmacists. Results: Thirty percent of the pharmacists returned a completed questionnaire. Mean scores (MS) were calculated for specific CE topics. The top three CE topics were: update professional skills (MS = 4.46); current standards of care (MS = 3.9); and professional practice standards (MS = 3.85). CE topics for clinical skills were also highlighted and included pharmacology and therapeutics, infectious disease, and patient education. CE topics specific to HIV included drug interactions, resistance, management of adverse events, opportunistic infections, alternative therapies, HAART therapy, post-exposure prophylaxis, and pregnancy in HIV/AIDS. Most pharmacists (81%) had access to Internet and e-mail (76%). Few respondents had access to teleconference (19%) and videoconference (11%). Pharmacists' preferences for CE delivery times were workday evenings (2–3 hours), weekend half-day, and workday half-day. Conferences, correspondences courses, structured courses, and seminars were the preferred delivery modes. Conclusions/Implications: Pharmacists in NL appear to have specific educational needs. Although the study achieved a lower-than-expected response rate, perhaps partly due to its length, most respondents indicated that computer-based technology could enhance the delivery of CE. Continuous, discipline-specific, real-time assessment of educational needs may be essential for optimum management of patients with HIV. It is likely the findings reflect the needs of pharmacists across the country, especially those outside urban areas. The preferences identified in this study could apply to delivering CE for a variety of diseases.
An Assessment of Patient Knowledge and Awareness of Issues Surrounding Cholesterol Risk Management
Authors: Olson Kari L. , Gromnisky Lisa 
Published: June 2013

Background: A lack of patient understanding and awareness of issues surrounding cholesterol risk management may be one reason that a significant number of patients receiving cholesterol-lowering therapy do not achieve optimal cholesterol levels. This study was conducted to assess patients' knowledge and awareness of issues surrounding cholesterol risk management. Methods: Community pharmacists within the Edmonton, Alberta, area were identified and asked to recruit patients within their practice who had been receiving cholesterol-lowering therapy for a minimum of six weeks. A 32-question telephone survey was developed and used as the instrument to assess patient knowledge and awareness. All surveys were conducted by the same individual, and data analysis was primarily descriptive. Results: Seventeen community pharmacies recruited 136 potential subjects over an eight-week period. Surveys were conducted with 105 (77%) of the eligible subjects. Of those surveyed, 37% identified elevated cholesterol as a risk factor for heart disease. While the majority of respondents felt it important to know their cholesterol targets (82%) and their specific levels (91%), only 23% and 29% of respondents indicated that they knew their high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels, respectively. Gaps in knowledge with respect to cholesterol-lowering therapy also existed. Conclusions: The results of this survey indicate gaps in patient knowledge of various issues surrounding cholesterol risk management. Pharmacists are in an excellent position to provide better education to patients about cholesterol levels and cardiovascular disease risk management. Further research is required to determine whether improved patient knowledge leads to improved clinical outcomes.
Barriers to General Practitioner Participation in a Clinical Trial Initiated by Pharmacists
Authors: Bateni Bita , Shalansky Stephen , Simpson Scot 
Published: June 2013

Objective: The purpose of this study was to determine general practitioners' (GPs) reasons for not entering patients into a randomized trial that compared outpatient anticoagulation management by community pharmacists with that of physicians. Methods: An anonymous survey was mailed to all GPs who were invited to participate in the anticoagulation study ( n = 118). Results: Completed surveys were received from 78/110 (71%) of GPs who had declined to participate in the anticoagulation study. Of those who had consented to participate, 8/8 completed surveys were received. The top-ranked reasons for not entering patients were “pharmacist should accept legal liability” (40%), “concern about other health care professionals taking over physician responsibilities” (33%), and “concern about responsibility for my patients” (29%). Other frequently cited barriers included concern about pharmacists' ability to manage warfarin patients, general issues related to control over patient care decisions, and lack of time. The top-ranked reason for agreeing to participate was the belief that “research advances the profession” (87%). Shortly after this survey, a statement published by the College of Physicians and Surgeons of BC reinforced physicians' concern about legal liability and recommended that physicians avoid referring patients to community pharmacy—based anticoagulation programs. Conclusion: Pharmacists who plan to conduct research in the community setting should thoroughly investigate potential barriers to GP involvement in patient recruitment, because of the difficulty in anticipating the most crucial issues. Local physicians may not support pharmacy-based anticoagulation programs, whether or not they are implemented as part of a clinical trial.
Pharmacist Intervention in Risk Reduction Study: High-Risk Cardiac Patients
Authors: Semchuk William , Taylor Jeffrey , Sulz L. , Deschamps M. , Tsuyuki Ross T. , Duffy P. , Wilson T. 
Published: June 2013

Objectives: Although there are guidelines for managing patients at high vascular risk, many people remain undertreated. This community-based study was designed to 1) measure the ability of the pharmacist—physician collaboration to affect a broad array of drug-related endpoints and 2) to compare 2 methods of training community pharmacists to collaborate with physicians on cardiac patient care. This paper focuses on the first outcome, and a companion paper will address the second outcome. Methods: We used a before-and-after design to assess pharmacists' ability to affect drug-related endpoints. We identified patients by various methods, one of which was medication profiles. Those providing consent were educated on risk factor modification and encouraged to consult their physicians. Pharmacists subsequently faxed the details of their assessments to the primary care physician, along with suggestions for therapy changes. Our outcome measure was the proportion of patients who achieved a composite of either a dose increase or a new target medication as a result of pharmacist recommendations during the study. Results: A total of 61 pharmacists recruited 217 patients, and of these, follow-up was completed on 216. Of the patients for whom a pharmacist made a suggestion, pharmacologic risk reduction therapy was initiated or enhanced in 53.7%. Conclusion: This community pharmacist—based program improved utilization of the therapies known to decrease vascular risk in patients considered high risk.
An Interdisciplinary Medication Management Program for Seniors in the Community
Authors: Waite Nancy , MacKeigan Linda , Chan D. , Wichman Kristina , Applebaum R. , VanderBent S. 
Published: June 2013

Background: The call for medication management programs (MMPs) is growing, as evidence of inappropriate prescribing and medication use in seniors accumulates. Seniors in social and supportive housing programs are likely at high risk of medication problems by virtue of their socioeconomic status and/or frailty. Yet there are few published reports of MMPs in such settings. Aim: To assess the need for medication management support for seniors in a supportive housing setting; to profile a pharmacist's medication management interventions; and to evaluate the costs, barriers, facilitators, and impact of a MMP. Method: Eleven seniors' apartment buildings in Peel region, served by 1 supportive housing provider, were randomized to experimental or control groups. Seniors in experimental buildings were referred to the MMP by supportive housing supervisors, health care professionals, or themselves. A pharmacist conducted in-home medication reviews. Her drug therapy assessment and recommendations were faxed to the family physician, and shared with other health care providers and caregivers as appropriate. Medication counselling and management aids were provided as needed. On average, clients received 1.7 follow-up visits or phone calls. Medication regimen complexity, adherence, and costs will be compared between groups at 3 months. Additional measures in the experimental group include number of pharmacist-identified medication problems and interventions, acceptance of prescribing recommendations, client and health care provider satisfaction, and service cost. Results: Almost 100 clients have received the service. Of the first 50 clients, 83% were female, with a mean age of 77.7 years and an average of 8 prescription drugs and 2 nonprescription medicines each. The pharmacist identified 2.5 medication problems per client and made 1.7 prescriber interventions and 1.1 client interventions. The most common medication problem (31%) was needing an additional drug and 67% of prescribing recommendations were known to be adopted or accepted. The service required 3.9 hours of pharmacist time per client. Data analysis is in progress. Implications for pharmacists: In-home medication management reviews improve seniors' drug therapy. Opportunities exist for pharmacists to provide this service in nontraditional settings, such as supportive housing or home care programs, thus increasing access and integrating primary care and community care providers in a coordinated medication support system for seniors.
Drug-Related Problems Identified in a Workplace Asthma Self-Management Program
Authors: MacKinnon Neil J. , Morais Chantal LeCouteur , Rose Theresa 
Published: June 2013

Background/Objective: Drug-related problems (DRPs) commonly lead to many adverse outcomes in patients with asthma. The objective of this study was to identify DRPs, potential DRPs, and non-DRPs in a workplace asthma self-management program. Methods: “Inspire at Work” is a unique workplace asthma self-management program that is a partnership between Medavie Blue Cross (a benefits carrier) and 7 large employers in New Brunswick. As part of this program, a certified asthma educator conducted 4 in-depth assessments for each participant. The reports from these assessments were independently reviewed by a pharmacist-researcher to classify the drug-related problems, potential DRPs, and non-DRPs identified by the asthma educator. Results: Ninety-nine patients completed the Inspire at Work program, and 46 DRPs were identified in 34 patients. The most common types of DRPs were untreated indications (20 patients), failure to receive drugs (12 patients), and subtherapeutic dosage (11 patients). A total of 188 problems were found — an average of 1.90 problems per patient. Conclusion: A significant number of problems in the care of patients with asthma were identified as part of this workplace asthma self-management program. Further stages in this study will examine the relationship of these problems to adverse clinical outcomes and the utilization of health care resources.
Enhanced medication management services in the community
Authors: Riley Karen 
Published: June 2013

Background: Pharmacists are now receiving reimbursement by the Ontario government to do medication reviews for patients on 3 or more medications. However, they are often too busy in the community setting to thoroughly review medications with patients. Having a designated pharmacist to provide medication reviews could increase the number of reviews performed. Methods: Step 1 involved developing a business plan to determine the number of medication reviews that needed to be done to pay a pharmacist a full-time salary. Step 2 involved establishing the core elements of medication therapy management that included medication review, a medication-related action plan, documentation and follow-up. In step 3, eligible patients were called and invited to attend an appointment to review their medications with the pharmacist. Upon completion of the medication reviews, a random group of patients were requested to complete a satisfaction survey after the medication review. Results: Three hundred thirty-six patients received billable medication reviews from April 4 to July 27, 2012. Twenty-seven additional visits were performed as follow-up visits. Eighty pharmaceutical opinions met the eligibility criteria for billing. Fifteen patients received counselling for smoking cessation. Medication reviews were completed for 19 patients from 8 other pharmacies. Extra revenue was generated through the sales of replacements of expired products. An average of 2.08 drug-related problems per patients was identified. One hundred percent of the patients were very satisfied with the service. Conclusion: A full-time pharmacist position providing enhanced medication management services generated enough income to pay for a full-time pharmacist’s salary. The benefits to the patients were an increase in identification and resolution of drug-related problems, as well as an opportunity to receive disease state education and experience an improvement in disease states. Patients were extremely satisfied with the medication review process and the service provided to them. Can Pharm J 2013;146:162-168.
Responsibility and confidence
Authors: Frankel Grace Elisabeth Charlotte , Austin Zubin 
Published: June 2013

Background: Despite the changing role of the pharmacist in patient-centred practice, pharmacists anecdotally reported little confidence in their clinical decision-making skills and do not feel responsible for their patients. Observational findings have suggested these trends within the profession, but there is a paucity of evidence to explain why. We conducted an exploratory study with an objective to identify reasons for the lack of responsibility and/or confidence in various pharmacy practice settings. Methods: Pharmacist interviews were conducted via written response, face-to-face or telephone. Seven questions were asked on the topic of responsibility and confidence as it applies to pharmacy practice and how pharmacists think these themes differ in medicine. Interview transcripts were analyzed and divided by common theme. Quotations to support these themes are presented. Results: Twenty-nine pharmacists were asked to participate, and 18 responded (62% response rate). From these interviews, 6 themes were identified as barriers to confidence and responsibility: hierarchy of the medical system, role definitions, evolution of responsibility, ownership of decisions for confidence building, quality and consequences of mentorship and personality traits upon admission. Discussion: We identified 6 potential barriers to the development of pharmacists’ self-confidence and responsibility. These findings have practical applicability for educational research, future curriculum changes, experiential learning structure and pharmacy practice. Due to bias and the limitations of this form of exploratory research and small sample size, evidence should be interpreted cautiously. Conclusion: Pharmacists feel neither responsible nor confident for their clinical decisions due to social, educational, experiential and personal reasons. Can Pharm J 2013;146:155-161.
Basketball Coaches’ Utilization of Ankle Injury Prevention Strategies
Authors: McGuine Timothy A. , Hetzel Scott , Pennuto Anthony , Brooks Alison 
Published: June 2013

Background: Ankle injuries are the most common high school basketball injury. Little is known regarding the utilization of ankle injury prevention strategies in high school settings. Objective: To determine high school basketball coaches’ utilization of ankle injury prevention strategies, including prophylactic ankle bracing (PAB) or an ankle injury prevention exercise program (AIEPP). Study Design: Cross-sectional survey. Methods: The survey was distributed to all high school basketball coaches in Wisconsin. Fisher exact and Wilcoxon rank sum tests were used to determine if the injury prevention strategies utilized differed according to school size, sex of the team, years of coaching experience, and the coach’s education level. Results: Four hundred eighty (55%) coaches from 299 (74%) high schools completed the survey. Thirty-seven percent of the coaches encouraged or required their players to use PAB. School enrollment of the coaches’ teams did not affect their stance on the use of PAB ( P = 0.30), neither did the sex of the team ( P = 0.16), years coaching ( P = 0.09), nor the coach’s education ( P = 0.49). Fifty percent (n = 242) of the coaches indicated they do not utilize an AIEPP, with no difference based on school enrollment ( P = 0.47), team sex ( P = 0.41), years coaching ( P = 0.78), or the education level ( P = 0.44). Barriers to utilization of AIEPP included a lack of time, awareness, and expertise. Coaches preferred an AIEPP that was specific to basketball, combined injury prevention and performance enhancement components, was performed 2 to 3 days per week, and lasted 5 to 15 minutes. Conclusion: Less than half of the coaches encouraged use of PAB, and half did not utilize an AIEPP. Coaches had specific preferences for the type of AIEPP they would implement. Clinical Relevance: Sports medicine providers should promote ankle injury prevention strategies but need to address why prevention strategies may not be utilized in high school basketball settings.
Reported Concussion Rates for Three Division I Football Programs
Authors: Kilcoyne Kelly G. , Dickens Jonathan F. , Svoboda Steven J. , Owens Brett D. , Cameron Kenneth L. , Sullivan Robert T. , Rue John-Paul 
Published: June 2013

Background: There has been increased interest in the number of concussions occurring in college football over the past year. In April 2010, the National Collegiate Athletic Association (NCAA) published new guidelines for the diagnosis and treatment of concussions in student athletes. Purpose: To determine the number of concussions that occurred on 3 collegiate Division I military academy football teams prior to and following recent changes in the NCAA concussion management policy. Study Design: Descriptive epidemiology study. Methods: Injury reports were reviewed from 3 Division I military academy football teams. The number of concussions that occurred over the 2009-2010 and 2010-2011 seasons, including those sustained in practice and game situations, was determined for each team. Incidence rates were compared using the exact binomial method. Results: The combined concussion incidence rate doubled from 0.57 per 1000 athlete exposures in the 2009-2010 season to 1.16 per 1000 athlete exposures in the 2010-2011 season (incidence rate ratio, 2.04; 95% CI, 1.2-3.55; P = 0.01). The combined numbers of concussions for the 2009-2010 and 2010-2011 seasons were 23 (40,481 exposures) and 42 (36,228), respectively. Conclusion: The combined incidence rate of concussions for the 2010-2011 season doubled from the previous season after the implementation of new NCAA policies on concussion management. While the institution of a more formalized concussion plan on the part of medical staff is one possible factor, another may have been the increased recognition and reporting on the part of players and coaches after the rule change.