Browsing by Subject "community pharmacy"
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Item Assessing the acceptability of community pharmacy based pharmaceutical care services in Karachi(University of Minnesota, College of Pharmacy, 2011) Amir, MuhammadProvision of pharmaceutical care services in community pharmacies is a new trend in pharmacy practice worldwide. Published literature from developed countries is available showing benefits of pharmaceutical care services provided in community pharmacies. However, relatively little published literature is available from developing countries in which unique market environments are encountered. This study was conducted to assess the acceptability of community pharmacy based pharmaceutical care services in Karachi. Pharmaceutical care services were developed and offered to pharmacy customers for a period of two months. Acceptability was evaluated with respect to enrollment of participants in the program, discontinuation, and complaints registered. The findings provide a better understanding of pharmaceutical care marketing strategies and are discussed within the context of the health care environment in Karachi.Item Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population(University of Minnesota, College of Pharmacy, 2013) Kelling, Sarah E.; Bright, David R.; Ulbrich, Timothy R.; Sullivan, Donald L.; Gartner, James; Cornelius, Douglas C.Objective: To describe successes and barriers with the development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population. Setting: A single supermarket chain pharmacy Practice description: Community pharmacists provide dispensing and non-dispensing pharmacy services including medication therapy management, biometric wellness screenings, and immunizations. Practice innovation: Developed and implemented a community pharmacy medication therapy management-based transition of care program for patients with managed Medicaid Main outcome measures: Feasibility of developing and implementing a transition of care service in a community pharmacy Results: During the first six months, a total of 17 patients were seen as part of the program. Study pharmacists identified successes and potential strategies for overcoming barriers. Conclusion: Developing and implementing a community pharmacy transition of care program for patients with managed Medicaid was logistically feasible.Item The Development of a Community-Based, Pharmacist-Provided Falls Prevention MTM Intervention for Older Adults: Relationship Building, Methods, and Rationale(University of Minnesota, College of Pharmacy, 2014) Mott, David A.; Martin, Beth; Breslow, Robert; Michaels, Barb; Kirchner, Jeff; Mahoney, Jane; Margolis, AmandaThe objectives of this article are to discuss the process of community engagement experienced to plan and implement a pilot study of a pharmacist-provided MTM intervention focused on reducing the use of medications associated with falling, and to present the research methods that emerged from the community engagement process to evaluate the feasibility, acceptance, and preliminary impact of the intervention. Key lessons learned from the community engagement process also are presented and discussed. The relationship building and planning process took twelve months. The RE-AIM framework broadly guided the planning process since an overarching goal for the community partners was developing a program that could be implemented and sustained in the future. The planning phase focused on identifying research questions that were of most interest to the community partners, the population to study, the capacity of partners to perform activities, and process evaluation. Much of the planning phase was accomplished with face-to-face meetings. After all study processes, study materials, and data collection tools were developed, a focus group of older adults who represented the likely targets of the MTM intervention provided feedback related to the concept and process of the intervention. Nine key lessons were identified from the community engagement process. One key to successful community engagement is partners taking the time to educate each other about experiences, processes, and successes and failures. Additionally, partners must actively listen to each other to better understand barriers and facilitators that likely will impact the planning and implementation processes. Successful community engagement will be important to develop both formative and summative evaluation processes that will help to produce valid evidence about the effectiveness of pharmacists in modifying drug therapy and preventing falls as well as to promote the adoption and implementation of the intervention in other communities.Item Differences in career paths and attributes of pharmacists completing a community pharmacy residency program (CPRP)(University of Minnesota, College of Pharmacy, 2014) Ulbrich, Timothy R.; Adams, Alex; Bright, David R.; Sullivan, Donald L.; Schnur, Evan; Bess, D. Todd; Owen, James; Bradley-Baker, LynetteObjective: To determine any differences in career paths and career attributes of pharmacists who have completed a PGY1 community pharmacy residency program (CPRP) as compared to those that have not completed a PGY1 CPRP. Methods: A web-based survey evaluating various aspects of community pharmacists’ careers was distributed to 274 CPRP graduates in addition to a random sample of 7,376 community pharmacists. The survey contained 32 questions evaluating various career attributes. Questions that assessed level of agreement were on a 6-point Likert-type Scale (1=strongly disagree; 6=strongly agree). Results: A total of 353 participants completed the survey, with 224 indicating that they had not completed a CPRP. Pharmacists who completed a CPRP responded that they spend significantly more time on patient care services, teaching, and research, and spend less time dispensing medications compared to those that have not completed a CPRP. Compared to those that did not complete a CPRP, CPRP graduates were less likely to agree that current level of workload negatively impacts job performance, motivation to work, job satisfaction, mental/emotional health, and physical health. Conclusion: Pharmacists completing a CPRP noted significant differences in their current employment and job responsibilities. Additional expansion and education regarding the importance of CPRPs should be considered.Item The Effect of a Novel Proactive First Day Prescription Counseling Program on Adherence to Select Cardiovascular Medications(University of Minnesota, College of Pharmacy, 2011) McConaha, Jamie L.; Lynch, KevinObjective: To determine the impact of a proactive first day prescription counseling program on medication adherence to new cardiovascular maintenance medications Design: Cross-sectional study Setting: Regional chain community pharmacy in Pittsburgh, Pennsylvania; August 2009 through November 2010 Patients: Data was collected from all patients aged 18-89 presenting with a new or transferred prescription or change in dosage within the study dates at four study locations Interventions: Patients presenting with a new or transferred prescription or change in dosage were identified to receive pharmacist or student pharmacist counseling. Data from the counseling session was tracked weekly to determine if the program increased adherence to statins, ACEIs and/or ARBs. Main Outcome Measured: Adherence to statins, ACEIs and/or ARBs was determined by differences in proportion of days covered (PDC) at six months and medication persistence to therapy. Results: Analysis was conducted using IDNA sm software. Results of the 6,916 prescriptions included in the study revealed that persistence rates for statins was 32.5% (intervention) and 34.2% (control) (p<0.001); ACEI/ARBs persistence was 37.3% (intervention) and 43.2% (control) (p<0.001). PDC was nonsignificant with respect to statins; 43.2% (intervention) and 45.1% (control); and 50.2% (intervention) and 57.1% (control) (p<0.001) for the ACEI/ARBs. Conclusion: Results from this study showed no improvement in adherence of statins or ACEIs/ARBs with the D1TC program versus control pharmacies, although several important limitations were identified. It is clear that a variety of methods and programs are needed to consistently improve adherence to maintenance medications.Item Establishing the Medication Safety Research Network of Indiana (Rx-SafeNet): Perspectives of Community Pharmacy Employees(University of Minnesota, College of Pharmacy, 2012-07) Seel, Lindsey V.; Hultgren, Kyle E.; Snyder, Margie E.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.Item Evaluation of an Initiative for Fostering Provider-Pharmacist Team Management of Hypertension in Communities(University of Minnesota, College of Pharmacy, 2014) Doucette, William R.; Lickteig, Cailin; Veach, Stevie; Carter, Barry; Levy, BarceyObjectives: 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.Item Examining the Effect of a Medication Synchronization or an Education Program on Health Outcomes of Hypertensive Patients in a Community Pharmacy Setting(University of Minnesota, College of Pharmacy, 2014) DiDonato, Kristen L.; Vetter, Kristin R.; Liu, Yifei; May, Justin R.; Hartwig, D. MatthewObjective: 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.Item Experience Developing a Community Pharmacy Practice-based Research Network(University of Minnesota, College of Pharmacy, 2012-07) Snyder, Margie E.; Frail, Caitlin K.; Seel, Lindsey V.; Hultgren, Kyle E.In 2010, the Purdue University College of Pharmacy established the Medication Safety Research Network of Indiana (Rx-SafeNet), the first practice-based research network (PBRN) in Indiana comprised solely of community pharmacies. In the development of Rx-SafeNet and through our early project experiences, we identified several “lessons learned.” We share our story and what we learned in an effort to further advance the work of the greater PBRN community. We have formed the infrastructure for Rx-SafeNet, including an Executive Committee, Advisory Board, member pharmacies/site coordinators, and Project Review Team. To date, 22 community pharmacies have joined and we have recently completed data collection for the network’s first project. Lessons learned during the development of Rx-SafeNet may benefit PBRNs nationally. Although community pharmacy PBRNs are not yet commonplace in the U.S., we believe their development and subsequent research efforts serve as an important avenue for investigating medication use issues.Item Identifying medication-related needs of HIV patients: foundation for community pharmacist-based services(University of Minnesota, College of Pharmacy, 2014) Kauffman, Yardlee; Barkowitz, Elana; Cerussi, Nicole; Pringle, Jan; McGivney, MelissaBackground: Patients living with HIV/AIDS have complex medication regimens. Pharmacists within community pharmacy settings can have a role managing patients living with HIV/AIDS. Patients’ perspectives surrounding implementation about community pharmacist-based services is needed as limited information is available. Objective: To identify medication-related needs of HIV-infected patients who receive prescriptions from a community pharmacy. To determine patient perspectives and knowledge of community pharmacist-based services. Methods: A qualitative research study involving in-depth, semi-structured interviews with patients was conducted. Inclusion criteria included: HIV positive men and women at least 18 years of age who receive care at a HIV clinic, currently take medication(s) and use a community pharmacy for all prescription fills. Patients were recruited from one urban and one rural health center. Patients answered questions about their perceptions and knowledge about the role and value of pharmacy services and completed a demographic survey. The recordings of the interviews were transcribed verbatim and were analyzed using principles of Grounded Theory. Results: Twenty-nine interviews were conducted: 15 participants from the urban site and 14 from the rural site. Five main themes emerged including: patients experience ongoing and varying medication-related needs; patients desire a pharmacist who is caring, knowledgeable and integrated with health care providers; patients expect ready access to drug therapy; patients value an individualized patient encounter, and patients need to be informed that a pharmacist-service exists. Conclusion: Patients with HIV value individualized and personal encounters with pharmacists at time intervals that are convenient for the patient. Patients felt that a one-on-one encounter with a pharmacist would be most valuable when initiating or modifying medication therapy. These patient perspectives can be useful for pharmacists and pharmacies interested in providing advanced care to patients with HIV.Item Implementation of a financially incentivized weight loss competition into an already established employee wellness program(University of Minnesota, College of Pharmacy, 2014) Schramm, Andrew M.; DiDonato, Kristen L.; May, Justin R.; Hartwig, MatthewObjective: 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 pharmaLJ ůŽĐĂƚŝŽŶƐ 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<0.05) ŝŶ ƐƵďŐƌŽƵƉ ĂŶĂůLJƐŝƐ. Pearson correlation coefficients between healthy lifestyle practice points earned and clinical measurements were significant for total cholesterol (r = -0.54), LDL-C (r = -0.50) and triglycerides (r = -0.49). 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.Item Implementation of a Pharmacist-Directed Cardiovascular Risk and Medication Management Program for Participants in a Construction Trade Benefit Trust Fund(University of Minnesota, College of Pharmacy, 2010) Liu, Yifei; McDonough, Randal P.; Carruthers, Kara M.; Doucette, William R.; Miller, KathleenObjectives: (1) To report the results of a pharmacist-directed cardiovascular risk management program; and (2) to identify obstacles faced by the pharmacists in the program implementation. Methods: The collaborators in this study included two local unions, a health benefit consulting company, and a community pharmacy. A total of 750 union workers with cardiovascular risk were informed about the cardiovascular risk management program. The program lasted six months, and the participation was voluntary. There were three group educational sessions with each session followed by a medication management service. A staff person of the health benefit consulting company and two pharmacists were interviewed via telephone. The interview questions were created according to the Gaps Model of Service Quality. The Gaps Model theorizes five gaps among consumer expectations, consumer perceptions, management perceptions of consumer expectations, service quality, service delivery, and external communications to consumers. The following data were collected: (1) types and quantity of drug therapy problems, (2) pharmacists’ recommendations and prescribers' response, (3) patients’ quality of life, disability days, and sick days, and (4) the experience of involved parties. Descriptive statistics were calculated. Results: Fifteen union workers participated in the program. For the participants, 35 drug-related problems were identified, with “need for additional therapy” and “dose too low” being the most common problems. To address these drug-related problems, pharmacists made 33 recommendations to prescribers, and prescribers accepted 55% of the recommendations. According to the interviews, there were three barriers faced by pharmacists to implement the program: lack of consensus about the recruitment, union workers’ unawareness of the program’s benefits, and limited support from the unions and the health benefit consulting company. Conclusions: It was difficult to recruit participants into the program. Clear agreement among collaborators on both the program’s benefits and the specific roles of each collaborator may be the key to successfully implement similar programs in the future.Item Integrating Components of Medication Therapy Management Services into Community Pharmacy Workflow(University of Minnesota, College of Pharmacy, 2014) Lester, Corey A.; Helmke, Jennifer L.; Kaefer, Tana N.; Moczygemba, Leticia R.; Goode, Jean-Venable R.Objective: The objective of this study was to develop and evaluate a process for integrating components of medication therapy management services into a community pharmacy workflow. Secondary objectives were to evaluate outcomes as well as patient and pharmacist satisfaction with this change. Methods: This prospective, 3-month observational study took place in a small, independent community pharmacy. This intervention included a redesigned work system that included a seated private desk area and focus on the pharmacist, rather than the technician, being the first contact when patients entered the pharmacy. Pharmacists participated in a focus group before and after the implementation of the new workflow to better understand the delivery of the intervention and assess satisfaction. Process outcomes included time spent with the patient, the number of medication-related problems identified and recommendations made, the type of disease education provided, type and number of immunizations administered, and health monitoring tests performed. Patient satisfaction surveys were distributed after completing the intervention during the third month of the study. Results: A total of 56 patients were enrolled in this study resulting in 82 encounters. Forty medication-related problems, including experiencing an adverse drug reaction and ineffective therapy, were identified with recommendations made to patients or prescribers. Disease education, such as goals of therapy, was provided 46 times. Health monitoring tests, such as blood pressure, were performed 16 times and eight immunizations were administered. The revised workflow incorporating components of MTM services was successful in that 39% of encounters were less than two minutes and 49% of encounters were between two and five minutes in length. Only 12% of encounters were greater than five minutes. Overall, patients were very satisfied with the intervention. Pharmacists responded positively, but expressed concern that the changes to the work system prevented them from overseeing technician functions. Conclusion: Pharmacists in community practice are able to provide components of medication therapy management services during a brief, face-to-face interaction with patients. Overall, patients and pharmacists were satisfied with the changes to the pharmacy work system and that additional work system changes are needed to further expand the role of the community pharmacist and facilitate patient-pharmacist interactions.Item Pharmacists’ social authority to transform community pharmacy practice(University of Minnesota, College of Pharmacy, 2011) McPherson, Timothy; Fontane, PatrickLeaders in the profession of pharmacy have articulated a vision of pharmacists as providers of patient-centered care (PCC) services and the Doctor of Pharmacy was established as the required practice degree to achieve this vision. Pharmacist-provided PCC services have been shown to reduce medication costs and improve patient compliance with therapies. While community pharmacists are capable of, and are ideally placed for, providing PCC services, in fact they devote most of their time to prescription dispensing rather than direct patient care. As professionals, community pharmacists are charged with protecting society by providing expert services to help consumers manage risks associated with drug therapies. Historically pharmacists fulfilled this responsibility by accurately dispensing prescription medications, verifying doses, and allergy checking. This limited view of pharmacy practice is insufficient in light of the modern view of pharmacists as providers of PCC. The consumers’ view of community pharmacy as a profession represents a barrier to transforming the basis of community pharmacy from product distribution to providing PCC services. Community pharmacists are conferred with social authority to dictate the manner in which their professional services are provided. Pharmacists can therefore facilitate the transition to PCC as the primary function of community pharmacy by exercising their social authority to engage consumers in their roles in the new patient-pharmacist relationship. Each pharmacist must decide to provide PCC services. Suggestions for initiating PCC services in community pharmacy are offered.Item A pilot project to assess community pharmacists’ knowledge and caring behaviors for recurrent headache sufferers after a migraine-focused educational intervention(University of Minnesota, College of Pharmacy, 2014) Murray, Kelly A.; Skomo, Monica L.; Carter, Sandra M.Objectives: (1) Compare pharmacists’ self-assessed knowledge of migraine before and after an educational intervention; (2) Compare pharmacists’ self-reported care behaviors following an educational intervention with a control group of pharmacists; (3) Identify interactions between the educational intervention results and individual independent variables. Design: Quasi-experimental, parallel design. Setting: Twenty community pharmacies in northeastern Oklahoma from March to May 2010. Participants: 49 pharmacists at one of twenty community pharmacies, with active and in-good-standing Oklahoma pharmacy licenses. Intervention: Two-hour educational session on migraine identification and current treatment. Main outcome measures: Compare pharmacists’ self-assessed knowledge of migraine before and after an educational intervention and compare self-reported care behaviors of these same pharmacists with a control group of pharmacists. Results: Pharmacists’ self-assessed knowledge mean scores were significantly higher post-intervention compared to pre-intervention (p<0.0001). Self-assessed knowledge was higher in the intervention group post-questionnaire scores compared to the control group of pharmacists (p=0.004). Intervention group pharmacists were more confident in their ability to maintain knowledge of migraine (p=0.04). No difference was seen regarding difficulty in providing care for a migraineur (p=0.16) or in how the pharmacists perceived employer culture (p=0.79). No significant interactions were found between the educational intervention and demographic variables collected. Conclusion: Attending an educational program on migraine improved pharmacists’ knowledge and confidence when providing care to migraineurs.Item Practice Change in Community Pharmacy: A Case Study of Multiple Stakeholders’ Perspectives(University of Minnesota, College of Pharmacy, 2012-10) Elrod, Shara; Snyder, Margie E.; Hall, Deanne; McGivney, Melissa A. Somma; Smith, Randall B.Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change. Design: Qualitative study. Setting: Community pharmacy in rural Mississippi. Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4), support staff (n=2), collaborating providers (n=4), patients (n=3), and a payer (n=1). Intervention: Semi-structured interviews and participant-observation techniques were used. Main outcome measures: Description of the community pharmacy’s practice and business model and identification of practice change facilitators. Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges. Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy’s successful establishment of a patient care practice.Item Prevalence of drug-related problems in self-medication in Danish community pharmacies(University of Minnesota, College of Pharmacy, 2012-12) Frøkjær, Bente; Bolvig, Tina; Griese, Nina; Herborg, Hanne; Rossing, CharlotteBackground: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this. Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine) identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems. Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies. Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC) medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs) were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines. Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner. Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect, unintended effects and, to a lesser extent, inappropriate self-medication.Item Project ImPACT: Hypertension Outcomes of a Pharmacist-Provided Hypertension Service(University of Minnesota, College of Pharmacy, 2014) Nemerovski, Carrie Wentz; Young, Maria; Mariani, Nicholas; Bugdalski-Stutrud, Carol; Moser, Lynette R.Objective: To evaluate the impact of pharmacists, working collaboratively with patients, on blood pressure control, lifestyle goal setting, adherence to antihypertensive therapy, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Methods: Self-declared hypertensive patients met with the pharmacist for blood pressure monitoring, lifestyle goal setting, and education about medications and disease state on four occasions over a 6–month period. Practice innovation: A community pharmacy partnered with an employer wellness plan to provide education and monitoring for patients with hypertension based on home blood pressure readings obtained using monitors that wirelessly transmit information to the pharmacist. Main outcome measure(s): Percentage of patients at blood pressure goal, mean blood pressure, percentage of patients with lifestyle goals, medication adherence, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Results: Patients not at their goal blood pressure at baseline had a significant decrease in blood pressure and a significant increase in achievement of their blood pressure goals. Across the population, no significant changes were seen in the primary outcome, lifestyle goals, medication adherence or modification of cardiovascular risk factors. Patient knowledge increased from baseline and satisfaction with the service was high. Conclusion: Blood pressure control improved in patients not at their treatment goal. All patients increased their knowledge about hypertension and reported high satisfaction with the pharmacy service. Pharmacy services should be offered to patients who are more likely to reap a benefit. Home blood pressure readings are useful to inform clinical decision making and supplement patient consultation within the pharmacy setting.Item Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management(University of Minnesota, College of Pharmacy, 2010) Branham, Ashley; Moose, Joseph; Ferreri, StefanieObjective: To determine if pharmacist-provided medication therapy management (MTM) improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR). Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR). Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC) and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8). Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43). However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08) following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.Item Transitions in Care: Medication Reconciliation in the Community Pharmacy Setting After Discharge(University of Minnesota, College of Pharmacy, 2013) Freund, Jeff E.; Martin, Beth A.; Kieser, Mara A.; Williams, Staci M.; Sutter, Susan L.Objective: To assess the feasibility of a workflow process in which pharmacists in an independent community pharmacy group conduct medication reconciliation for patients undergoing transitions in care. Methods: Three workflow changes were made to improve the medication reconciliation process in a group of three independent community pharmacies. Analysis of the process included workflow steps performed by pharmacy staff, pharmacist barriers encountered during the medication reconciliation process, number of medication discrepancies identified, and pharmacist comfort level while performing each medication reconciliation service. Key Findings: Sixty patient medication reconciliation services met the inclusion criteria for the study. Pharmacists were involved in all steps associated with the medication reconciliation workflow, and were the sole performer in four of the steps: verifying discharge medications with the pharmacy medication profile, resolving discrepancies, contacting the prescriber, and providing patient counseling. Pharmacists were least involved in entering medications into the pharmacy management system, performing that workflow step 13% of the time. The most common barriers were the absence of a discharge medication list (24%) and patient not present during consultation (11%). A total of 231 medication discrepancies were identified, with an average of 3.85 medication discrepancies per discharge. Pharmacists’ comfort level performing medication reconciliation improved through the 13 weeks of the study. Conclusions: These findings suggest that medication reconciliation for patients discharged from hospitals and long term care facilities can be successfully performed in an independent community pharmacy setting. Because many medication discrepancies were identified during this transition of care, it is highly valuable for community pharmacists to perform medication reconciliation services.