Browsing by Subject "pharmacist"
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Item Assessment of a pharmacist-led comprehensive medication management and wellness program(University of Minnesota, College of Pharmacy, 2015) Janovick, Daniel L.; Green, Tara R.; Bright, David R.Background: Pharmacists are currently providing comprehensive medication management in the outpatient setting. However, there is little documented evidence demonstrating pharmacists are generating further improved health outcomes utilizing non-pharmacologic support, such as fitness and nutrition counseling. The objective of this study is to determine if a pharmacist-led wellness program with medication management and lifestyle modifications through fitness and nutrition coaching can lead to improved biometric markers. Methods: The wellness program targeted corporate employees and was offered in a corporate headquarters' setting with an on-site workout facility. The program was expected to recruit approximately 15 patients into the wellness program consisting of two treatment arms. The standard group featured nutrition-based classes, medication therapy management and fitness education. The intervention group performed the standard group’s activities plus direct, supervised fitness training once weekly. Measured biometric markers were assessed at baseline, 3.5 months, and 7 months and included body mass index (BMI), waist circumference (WC), fasting blood glucose (FBG), systolic and diastolic blood pressure (SBP and DBP), and full lipid panel (TC, TG, HDL, and LDL). Results: Seventeen patients were enrolled in the study. The standard group (n = 11) and intervention group (n = 6) had relatively similar biometric markers at baseline. Seven total patients completed the study (4 from standard group, 3 from intervention group). The majority of biometric markers improved in both groups, and BP and LDL control was maintained for all who completed the study. Conclusion: These data suggest that a licensed pharmacist with certified personal trainer credentials may be capable of maintaining biometric markers at healthy levels and improving where necessary in an employee wellness program through one-on-one medication, fitness and nutrition support. Additional, large-scale research is needed to verify the clinical outcomes and feasibility in a larger group setting.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 Health-Related Quality of Life Impact in Employees Participating in a Pharmacist-Run Risk Reduction Program(University of Minnesota, College of Pharmacy, 2012-12) Lenz, Thomas L.; Gillespie, Nicole D.; Skrabal, Maryann Z.; Faulkner, Michele A.; Skradski, Jessica J.; Qi, Yongyue; Coleman, Abby W.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.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 Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management(University of Minnesota, College of Pharmacy, 2014) Lamb, Michelle M.; Wu, Weiwei; Lloyd, AnnThe 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.Item Impact of Pharmacists and Student Pharmacists in Educating and Screening Low-Income Women for Cardiovascular Disease(University of Minnesota, College of Pharmacy, 2012-07) DiPietro, Natalie A.; Sobota, Kristen Finley; Giannamore, Martin R.Objectives: To evaluate the effectiveness of an educational intervention on knowledge of cardiovascular disease (CVD) and to increase awareness of risk factors among female patients of a community health center with an on-site 340B pharmacy. Methods: The program consisted of a 10-minute educational intervention and brief pre-test, post-test, and participant satisfaction survey. Adult female patients at the clinic for any provider visit or prescription fill were eligible to participate. Participants met individually with a student pharmacist or faculty member and verbally completed the pre-test. The participant received education regarding CVD, risk factors, and symptoms of myocardial infarction and were screened for hypertension and/or hyperlipidemia. The post-test was then verbally administered. Participants answered the satisfaction survey privately. Based on individual needs, educational materials and information on available pharmacy clinical services were provided. The university IRB deemed the study exempt. Results: Eighty-four individuals received educational materials and/or a screening test. Of those, 30 women (mean age 46.9 years) completed the educational intervention. Thirteen (43%) reported smoking; 22 (73%) identified themselves as overweight. Fourteen (47%) indicated a preexisting diagnosis of hypertension. Correct responses for 6 of 8 knowledge-based questions were statistically significantly improved from pre-test to post-test (p<0.05). Twenty-nine patients (97%) rated the program as “useful” or “very useful”. Conclusion: CVD is the leading cause of death in U.S. women. Data from this program indicate that through screening and education, pharmacists and student pharmacists can impact female patients’ knowledge of CVD risk factors. Continued efforts in this area may help to reduce the public health burden of CVD.Item Lifestyle Medicine-Related Cardiovascular Risk Factor Changes in Employees Participating in a Pharmacist-Run Risk Reduction Program(University of Minnesota, College of Pharmacy, 2012-12) Lenz, Thomas L.; Gillespie, Nicole D.; Faulkner, Michele A.; Skrabal, Maryann Z.; Skradski, Jessica J.; Qi, Yongyue; Larson, Jessica C.Cardiovascular disease (CVD) remains the leading cause of death among American adults accounting for approximately one-third of all deaths. It has been shown, however, that the actual causes of death are related to lifestyle behaviors such as tobacco use, poor diet and physical activity and alcohol consumption. A pharmacist-run employee health program, started in 2008, sought to lower CVD risk through the use of individualized lifestyle behavior programming, medication therapy management, and care coordination activities. Following one year of participation in the program, employee participants were shown to significantly increase exercise quantity (p < 0.001), fruit and vegetable consumption (p < 0.001), and decrease self-reported stress level (p = 0.006). The percentage of program participants simultaneously adherent to the recommended levels of exercise, combined fruit and vegetable intake and tobacco abstinence at one-year was 34.5% vs. 5.5% at baseline. This compares with only 5.1% of the U.S. population adherent to the same three behaviors. Pharmacists can positively impact healthy lifestyle behaviors when working in an employee health setting.Item Medication Adherence Improvements in Employees Participating in a Pharmacist-Run Risk Reduction Program(University of Minnesota, College of Pharmacy, 2012-12) McKenzie, Mallory C.; Lenz, Thomas L.; Gillespie, Nicole D.; Skradski, Jessica J.Objective: To evaluate the medication adherence of individuals participating in a pharmacist-run employee health Cardiovascular and Diabetes Risk Reduction Program. Design: Retrospective analysis of medication adherence using pharmacy refill data. Setting: A medium sized university located in the Midwest United States and the organization’s outpatient pharmacy. Participants: 38 participants ≥ 18 years of age, employed and receiving their health insurance through the organization, and have a diagnosis of hypertension, hyperlipidemia, diabetes mellitus, or a combination thereof. Intervention: Participation in the risk reduction program that emphasizes medication therapy management (MTM), lifestyle medicine and care coordination. Main Outcome Measures: The Proportion of Days Covered (PDC) and the Medication Possession Ratio (MPR). Results: PDC and MPR analysis showed a statistically significant improvement in medication adherence for 180 days and 360 days post enrollment versus the 180 days prior to enrollment (P<0.01). The PDC analysis demonstrated a statistically significant improvement in the number of medications that achieved a PDC ≥ 80% (high adherence) for the 180 days post enrollment versus the 180 days prior to enrollment (+30%, P<0.01). The MPR analysis showed a non-statistically significant improvement in the number of medications that achieved an MPR ≥ 80% (high adherence) pre enrollment versus post enrollment (+10%, P=0.086). The percentage of participants in the program that reached a PDC and MPR adherence rate ≥ 80% at 180 days post enrollment was 78.9% and 94.4%, respectively which exceeds that of a matched cohort that reached a PDC and MPR adherence rate ≥ 80% of 66.4% and 82.8%, respectively. Conclusion: Pharmacists can improve medication adherence as measured by PDC and MPR when working with employees enrolled in a novel pharmacist-run employee health risk reduction program. Medication adherence was shown to be sustainable for at least one year and was shown to be better when compared to a matched cohort of similar age, condition and region.Item Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention(University of Minnesota, College of Pharmacy, 2014) Di Pietro, Natalie A.; Bright, David R.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.Item Pharmacist-Driven Management of Chemotherapy Induced Nausea and Vomiting in Hospitalized Adult Oncology Patients. A Retrospective Comparative Study(University of Minnesota, College of Pharmacy, 2011) Elshaboury, Ramy; Green, KathleenChemotherapy-induced nausea and vomiting (CINV) is a major adverse event associated with cancer treatments. There are clinical practice guidelines that assist practitioners in managing CINV. Many cancer centers develop protocols for physicians and pharmacists to guide prophylaxis and breakthrough treatments of CINV based on published guidelines. The purpose of this study was to evaluate the outcome differences between pharmacist and physician -driven management of CINV in adult hospitalized cancer patients in a large academic medical center. This is a single center retrospective chart review study. The primary outcome of the study was the number of breakthrough antiemetic doses needed throughout the hospitalization. A total of 106 adult patients receiving inpatient chemotherapy were reviewed for CINV management. Fifty-five patients (52%) were managed according to the pharmacist-driven protocol, and fifty-one patients (48%) were managed by the physician. There was no difference between the two groups in the primary outcome. Patients in the pharmacist-managed group needed 6.4 breakthrough antiemetic doses; whereas, patients in the physician managed group needed 5.9 doses throughout the hospital stay (P-value = 0.7). No difference was seen when results were adjusted for length of hospitalization. There was a difference in adherence to the institution CINV guidelines favoring the pharmacist-driven approach (85% versus 33%, P < 0.0001). In conclusion, pharmacist-run protocol for CINV management was as effective as the standard of care. Protocols that are based on practice guidelines may offer the advantage of care standardization and potential cost savings.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 Promotion of ethical principles in provision of medication therapy management services(University of Minnesota, College of Pharmacy, 2014) Kelling, Sarah E.; Aultman, Julie M.As pharmacists move toward more patient-centered care through medication therapy management (MTM), important issues and conflicts may arise within the therapeutic relationship, requiring pharmacists to use ethical knowledge and skills toward conflict-resolution. The purpose of this paper is to explore practical strategies that pharmacists and other champions of MTM may utilize to support the ethical principles of autonomy, veracity, nonmaleficence, beneficence, and justice, along with an ethic of care during the provision of MTM services. With a deeper understanding of ethical principles and the Code of Ethics for Pharmacists, pharmacists may be more prepared to make difficult ethical decisions, and ultimately, guide better patient care.