Volume 06, Number 1, 2015

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Health Information Exchange to Support a Prescription Drug Monitoring Program
(University of Minnesota, College of Pharmacy, 2015) Cochran, Gary L.; Klepser, Donald G.; Morien, Marsha; Lander, Lina
Objective: To describe barriers to the utilization of a query based Health Information Exchange (HIE) that supports a statewide Prescription Drug Monitoring Program (PDMP). Methods: Emergency room (ER) prescribers were surveyed bi-weekly and at the end of a four-month study to estimate HIE/PDMP utilization and identify barriers to utilization. Results: Self-reported utilization from seventeen providers in three emergency rooms was very low. Providers estimated that prescription history was rarely available when queried. Problem lists and laboratory reports were estimated to be available 60% of the time. Discussion: Barriers to HIE utilization for PDMP purposes included prescribers not finding the information they queried and lack of integration into clinical workflow. Low perceived need for PDMP and prescriber preparedness to manage abusers may also have reduced utilization. Recommendation: Financial and human resources must be available for training and integration of a HIE based PDMP into the ER’s clinical workflow. Minimizing information gaps is also necessary to increase utilization.
Pharmacovigilance Programme of India
(University of Minnesota, College of Pharmacy, 2015) Kumar, Duvvuru Ashok; Reddenna, Languluri; Basha, Shaik Ayub
Pharmacovigilance is defined as “the pharmacological science relating to the detection, assessment, understanding and prevention of adverse effects, principally long term and short term adverse effects of medicines.” It is an important and integral part of clinical research. India is the world’s second most populated country with over one billion potential drug consumers. Although, India is participating in the Uppsala monitoring center program, its contribution to that database is relatively small. This problem is essentially due to the absence of a robust ADR monitoring system and also the lack of awareness of reporting concepts among Indian health care professionals. The specific aims of pharmacovigilance are to advance patient care and safety in relation to the use of medicines and all medical and paramedical interventions, contribute to the assessment of benefit, harm, effectiveness, and risk of medicines, promising their safe, rational, and more effective use, promote indulgent, education, and clinical training in pharmacovigilance and its effective communication to the public. Pharmacovigilance methods must also be capable to designate which patients are at risk of developing an adverse drug reaction. A suitably working pharmacovigilance system is important if medicines are to be used prudently. It will be advantageous for healthcare professionals, regulatory authorities, pharmaceutical companies and consumers to monitor medicines for risk.
Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students
(University of Minnesota, College of Pharmacy, 2015) Skelley, Jessica W.; Carpenter, Chase; Elkins, Trisha; Woolley Jr, Thomas W.; Dugan, B. DeeAnn
Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP) during their Advanced Pharmacy Practice Experience (APPE) in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP’s and used for this purpose with participating students on their ambulatory care APPE. Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18) at the start of their ambulatory care APPE. The test was designed to assess both the students’ baseline knowledge regarding MRP’s, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest) to complete to assess if their knowledge had increased from baseline. Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP’s. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students’ knowledge or ability to properly identify and classify medication related problems (MRP) after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884). However, a statistically significant decline in students’ knowledge occurred on one specific question, which tested their ability to classify MRP’s (p = 0.029). Conclusions: Based on the results of the pre-test, students at our institution enter their APPE year with limited baseline knowledge of medication safety within the ambulatory care setting. Results from the posttest indicate potential ineffectiveness of a written document in providing effective education on MRP’s to students in the experiential setting. Education may be made more effective with a hands-on, active learning approach that overcomes the limitations of other passive forms of learning.
Technology in the Pharmacy Learning Environment: Surveys of Use and Misuse
(University of Minnesota, College of Pharmacy, 2015) Begley, Kimberley J.; Monaghan, Michael S.; Clavier, Cheri W.; Lugo, Ralph A.; Crouch, Michael A.
The use of technology in the classroom may have positive and negative effects on learning. The purpose of this investigation was twofold: to identify the effect technology is having on the pharmacy learning environment; and, to assess students’ use of technology during class time for non-academic purposes. This study included a national cross-sectional survey as well as a single, college-specific survey. The national survey had a faculty response rate of 71.2%. Of the responders, approximately 61% identified significant problems related to students’ use of technology in the pharmacy learning environment. Cell phones were a recognized concern and more than 90% of programs have chosen to restrict cell phone use in the classroom. The single college survey examining technology use during class for non-academic purposes had a student response rate of 87% and faculty response rate of 100%. Students and faculty members disagreed regarding the negative effects of technology use during class for non-academic purposes. Notably, 16% of students acknowledged their in-class use of technology for non-academic purposes had been disruptive to their learning, as compared to 95.7% of faculty. According to students, common reasons for off-task technology use included checking e-mail/text messages (75.1%), lack of engagement (58.1%), multitasking (56.2%), and accessing social media sites (33%). Faculty and students were asked about enforcement of technology policy. More faculty than students supported policy enforcement by faculty (65.2% versus 22.8%, respectively; p<0.001) as well as policy enforcement by students (78.3% versus 31.9%, respectively; p<0.001). Overall, technology use during class for non-academic purposes was common. Many schools and colleges of pharmacy are developing approaches to address these evolving issues by revising their technology use policies.
Method validation in pharmaceutical analysis: from theory to practical optimization
(University of Minnesota, College of Pharmacy, 2015) Eserian, Jaqueline Kaleian; Lombardo, Marcia
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.
Incentivizing Antibiotic Research and Development
(University of Minnesota, College of Pharmacy, 2015) Scandlen-Finken, Leah; Wertheimer, Albert
Antibiotic Resistance is an international threat, killing thousands and infecting millions. Although certain populations may be at an increased risk for infections, anyone can find themselves compromised with a multi-drug resistant infection. Treatments are becoming more complicated as the bacteria becomes more elusive. Cures are becoming less certain, and the future antibiotic arsenal is looking thin. Although there are many talented scientists and capable drug development entities, the funding and returns on investment are not sufficient to entice antibiotic research and development. This paper explores the current situation regarding antibiotic resistance and its casualties, as well as the mechanisms being employed to overcome the increase in resistance, and decrease in antibiotic effectiveness. Through analysis of antibiotic research, development, and regulation, this paper adds to the discussion by filling in the current gaps regarding the procurement of sustainable funding via an insurance model framework. By incentivizing the pharmaceutical industry to invest in antibiotic research, and by guaranteeing returns on investment, a global solution to the current antibiotic resistance problem can be contained.
A Profile of Retirement Age Pharmacists in Illinois
(University of Minnesota, College of Pharmacy, 2015) Quinones-Boex, Ana C.; Turgeon, Alyson
Introduction: This manuscript describes the unexpected results from a routine state survey of pharmacist workforce patterns. It describes the background characteristics, practice activities, working conditions, compensation, and fringe benefits among registered Illinois pharmacists of typical retirement age (≥ 65 years old) still active in practice. Methods: A 4-page self-administered questionnaire was mailed to a random sample of 500 registered pharmacists residing in Illinois in early 2013. A reminder postcard was mailed to the whole sample at two weeks from the initial correspondence. Data collection concluded three months after the initial mailing. Results: Response rate was 44.8%. Half of all respondents reported to be active in practice (n =119, 54.1%); most of these pharmacists reported working part-time (n= 92, 41.8%). Further inspection revealed that all respondents were age 65 or older. The average respondent could be characterized as a married, Caucasian male of typical retirement age. Respondents wanted significantly less time spent in medication dispensing (63.4%) and more time providing patient care services (27.5%). As expected, most work-related characteristics were significantly different between part-time and full-time respondents with one exception: there were no major differences in hourly wages observed. Conclusion: Based on data from this survey, there is a substantial number of retirement age pharmacists in Illinois who continue to practice past the age of 65. A better understanding of pharmacist retirement trends is of importance to the profession as it has potential implications for pharmacy employers, educational institutions, and other stakeholders.
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.
A Student-Initiated, Integrated Pharmacotherapeutics Learner-Centered Course
(University of Minnesota, College of Pharmacy, 2015) Hopman, Shawn; Popovich, Nicholas G.
Objective: To evaluate a learner-centered, elective course complementing pharmacotherapeutic instruction. Design: A one credit-hour elective as developed. Enrolled students were responsible for article selection and to lead in-class discussions. A content-validated discussant rubric was use to peer review each discussant. Assessment: Enrolled students kept current on the literature and nurtured an obligation to themselves and their peers to be prepared on a weekly basis to discuss the selected article. Discussion demonstrated varied opinions and provided ample opportunity for students to use technical/clinical language. Also, the course allowed for thinking at a higher level, discussing complex ideas/issues, and developing oral communication skills. Conclusions: This learner-centered approach allowed the enrolled students to take ownership of their learning and complement their learning from the traditional mode of learning in two pharmacotherapeutic courses. It encouraged the students to investigate the clinical literature as a means to complement and enhance their knowledge.
Pharmacists’ Roles and Factors Affecting Patient Care in Korea
(University of Minnesota, College of Pharmacy, 2015) Hwang, Monica J.; Young, Henry N.
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.
Improving Blood Pressure Control in Over-the-Road Truck Drivers: Is Provision of Medication Therapy Management by Pharmacists Feasible?
(University of Minnesota, College of Pharmacy, 2015) Hager, Keri D.; Aronson, Benjamin D.; Smith, Reid C.; Parra, David; Swanoski, Michael
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.