Volume 05, Number 3, 2014

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    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. Matthew
    Objective: To examine the effect of a medication synchronization or education program on hypertensive health outcomes. Methods: This study used a design of randomized controlled trial lasting four months taking place within a family-owned community pharmacy chain in a U.S. Midwestern state. A total of 302 hypertensive patients were randomized into 3 study groups – control, medication synchronization, and education. Interventions included management of medication refills through a medication synchronization program for the medication synchronization group, and monthly hypertension (HTN) education for the education group. Outcome measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), percentage of patients at blood pressure (BP) goal, self-rated change in medication adherence, and patients’ HTN knowledge. Results: All groups had significant decline of SBP from baseline; however the final analysis showed no significant SBP differences among study groups. The proportion of patients achieving BP goals in both the control (p=0.005) and education (p=0.019) groups increased at Month 4. Changes in self-reported adherence were not significant for any groups. All groups showed positive changes on HTN knowledge questions with the education group showing the greatest change. Conclusion: Compared to the control group, there was no difference in the primary outcomes. However, this study demonstrated that educational materials written at an appropriate level and presented by community pharmacists to patients may have been associated with an increase in HTN knowledge and a significant increase in the proportion of patients achieving their BP goal. These educational interventions had a greater impact on helping patients achieve their blood pressure goals than medication synchronization. This may indicate that further intervention is needed to impact adherence aside from ensuring that patients have their medication on hand. Taking the time to educate patients about hypertension led to self-reported positive change with being more careful about taking medications and with not forgetting to take medications when they felt better.
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    Identifying barriers to influenza vaccination recommendation adherence in an academic outpatient primary care clinic setting
    (University of Minnesota, College of Pharmacy, 2014) Buu, Jenni; Mullin, Shantel; McAdam-Marx, Carrie; Solomon, Margaret; Jennings, Brandon T.
    Objective: The objectives of this study were to identify barriers to influenza vaccination recommendation adherence and determine potential methods to improve influenza vaccination rates at the outpatient primary care health centers within an academic health care system. Methods: This descriptive study consisted of a questionnaire distributed to primary care providers at outpatient health centers within an academic health care system. The questionnaire assessed provider opinions regarding knowledge of influenza vaccination recommendations, barriers to following clinical guidelines, and methods to decrease delay of guideline use. Influenza vaccination rates at each of the health centers were also determined through documentation of vaccination for adults who visited a primary care provider during the 2011-2012 influenza season. Vaccination rates were used as a potential model for vaccination recommendation adherence. Results: When providers were asked about barriers to guideline implementation, 75.0% stated lack of awareness that guidelines have been released and 62.5% identified insufficient time to learn new guidelines as barriers. When asked which would be useful to more quickly implement clinical guidelines, respondents selected education for providers of new guidelines (79.2%), reminders in the electronic medical record (62.5%), and involvement of other health care professionals including pharmacists (54.2%) as potential strategies. Most questionnaire respondents (70.8%) strongly agreed that well-developed guidelines would improve quality of care at their practice site. During the 2011-2012 influenza season, 26.0% of 67,827 adults with an office visit at all outpatient health centers had documentation of administration of an influenza vaccine. Conclusion: Influenza vaccination rates at the outpatient primary care health centers at this academic health care system represent an area for improvement. Provider perceived barriers to clinical practice guideline implementation and adherence at the health centers include lack of awareness of new guidelines and lack of resources such as time and personnel to follow all recommendations. A health care system-wide process needs to be created to better identify strategies to improve adherence to influenza vaccination recommendations and vaccination documentation.
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    Evaluating the Impact of Drug Dispensing Systems on the Safety and Efficiency in a Singapore Outpatient Pharmacy
    (University of Minnesota, College of Pharmacy, 2014) Ong, Peter Y.S.; Chen, Li Li; Wong, Jane Ai; Gunawan, Yeyen; Goh, Wei Jiang; Tan, Mui Chai; Lee, Soo Boon
    Purpose: Automation of pharmacy workflow can reduce medication errors as well as improve efficiency of the medication picking, packing and labeling process. Since September 2012, two drug dispensing systems (DDS) began operations in the Singapore General Hospital Specialist Outpatient Clinic Pharmacy. This study sought to evaluate the impact of the DDS on safety and efficiency in the pharmacy. Methods: The primary outcome was the rate of prevented dispensing incidents contributed by DDS or manual picking of medications defined as the number of prevented dispensing incidents per 1000 medications picked. The secondary outcome was the productivity of each full time equivalent (FTE) when assigned to either the DDS or manual picking stations. Data pertaining to the primary and secondary outcomes between January and December 2013 were collected and analyzed. The rate of prevented dispensing incidents was expressed in median (interquartile range) and compared using Mann-Whitney U test. Other continuous variables were expressed in mean ± standard deviation and compared using independent samples t-test. Results: An average of 59494 medications was picked every month in the pharmacy. DDS accounted for 21.1 percent while manual picking accounted for 78.9 percent of all the medications picked. The median rate of prevented dispensing incidents per month committed by manual picking (2.73) was significantly higher than the DDS (0.00). DDS had greater productivity with each FTE in the DDS having an average of 6175 picks per month which was significantly higher than each FTE in the manual picking stations which had an average of 4867 picks per month. Conclusion: Installation of DDS in an outpatient pharmacy improved safety of the pharmacy workflow by automating the medication picking, packing and labeling process and minimizing human errors. Efficiency of the medication picking, packing and labeling process was also improved by the DDS as there were continuous efforts to boost their productivity as well as being more reliable and better able to handle fluctuations in patient load.
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    Immunization Tour: Preparing for Mass Immunization through Pharmacy and Nursing Interprofessional Student-led Service-learning
    (University of Minnesota, College of Pharmacy, 2014) Moon, Jean; Pfeiffer, Jeanne; Adwan, Jehad; Rudie, Maria; Uden, Don
    Pharmacy and nursing students piloted a collaborative student initiative to administer mass influenza immunizations to a large university campus. Through the support of the School of Nursing, College of Pharmacy, and University Health Service this project later turned into a unique service-learning interprofessional one credit elective course promoting public health philosophy and principles, emergency preparedness strategies, clinical skills, and interprofessional team competencies centered around influenza immunizations. Including lessons learned, this article will describe the evolution of this innovative student-led project.
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    Interview with the Medicine Man: A Case Study of a Traditional Malian Healer
    (University of Minnesota, College of Pharmacy, 2014) Rovers, John
    Pharmacists are commonly members of medical mission teams that provide health care services in underdeveloped countries. Although pharmacists and others often find their service on a mission trip to be positive and life changing, critics of such missions note that Western providers trained in biomedicine frequently lack the cultural awareness to practice effectively in such settings. This paper is a case study of one traditional healer who practices in rural Mali. Although the results of one case from one practice setting may not be generalizable to all cultures, a basic understanding of the healer’s beliefs and practices concerning the etiology and treatment of disease, the role of magic and other supernatural therapies, his experience with Western trained providers and the regulatory environment in which he works should assist pharmacists who serve on mission trips to be better culturally prepared.
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    Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8)
    (University of Minnesota, College of Pharmacy, 2014) Tan, Xi; Patel, Isha; Chang, Jongwha
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    Leadership: Three Key Employee-Centered Elements With Case Studies
    (University of Minnesota, College of Pharmacy, 2014) Summerfield, Marc
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    Experience and Outcomes of a Pharmaceutical Care Leadership Residency Program
    (University of Minnesota, College of Pharmacy, 2014) Bartelme, Kassandra M.; Bzowyckyj, Andrew; Frueh, Janice; Speedie, Marilyn; Jacobson, Gerald; Sorenson, Todd D.
    The University of Minnesota College of Pharmacy’s Ambulatory Care Residency Program has graduated 22 residents from its Leadership Emphasis program from 1999 to 2014. The Leadership Emphasis program is unique in its design, providing a set of experiences over two years focused on developing leadership skills in practice development, establishing personal influence, advocacy in the profession, and teaching. The program’s design has focused on bringing value to three distinct audiences: pharmacists enrolled in the program, the local pharmacy practice community, and the College of Pharmacy. This paper explores the program’s contributions in each of these areas. Program graduates from 1999-2009 were interviewed and cited the independent, yet mentored, activities of the program as instrumental to their professional and personal development. The program has provided significant value to the College of Pharmacy, primarily in the form of instructional support, service to faculty practice sites and development of new practice sites for APPEs. Teaching and precepting hours offset the salary of the residents, resulting in financial benefits for the College. In the second year of the program, residents pursue development of new practice sites, 15 of which have been sustained to provide at least a half-time pharmacist position, having a direct impact on pharmacy practice development in the region. The program provides a win-win-win situation for all the stakeholders involved. Schools and colleges of pharmacy are encouraged to consider whether a similar program may assist in achieving its own goals in practitioner development, teaching and learning, and community engagement.
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    Perceived Impact of a Longitudinal Leadership Program for All Pharmacy Students
    (University of Minnesota, College of Pharmacy, 2014) Mort, Jane R.; Strain, Joe D.; Helgeland, David L.; Seefeldt, Teresa M.
    Objective: To describe a longitudinal leadership program involving all students and report the perceived impact. Design: The program included a first year Leadership Interview, a third year Report of Leadership, and a fourth year Professional Business Meeting Attendance. Activities involved guided reflection. Assessment: Students (n=138) indicated the activities helped them recognize the importance of leadership and their leadership potential (e.g., 72.5% and 62.3% of students due to meeting attendance, respectively). Students participated in leadership activities that they would not have pursued otherwise, either in response to the activity (27.7% due to interview) or as a requirement of the activity (51.1% for leadership report). Students reported developing specific leadership skills through the activities. Most students planned to be involved in a district/regional (72.5%), state (84.1%), and national (51.4%) meeting in the five years following graduation. Conclusion: Students reported a positive impact on leadership perceptions and participation. The report is a preliminary step in the development and assessment of a longitudinal curricular initiative involving all pharmacy students.
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    How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration
    (University of Minnesota, College of Pharmacy, 2014) Hahn, Lindsay; Buckner, Martha; Burns, Georgeann B.; Gregory, Debbie
    Purpose: The Pharmacy Practice Model Initiative (PPMI) calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support. Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital’s pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy’s influence on a hospital’s bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI. Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together – and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families.
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    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, Matthew
    Objective: To assess improvement in clinical outcomes and patient satisfaction of a financially incentivized weight loss competition adjunct to a currently established pharmacist-directed employee wellness program. Design: Retrospective, cohort, pilot study Setting: 6 independent community pharmacy chain locations, two long-term care 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.
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    Recognizing and Disseminating Innovations in Scholarly Teaching and Learning to Support Curricular Change
    (University of Minnesota, College of Pharmacy, 2014) Janke, Kristin K.; Kolar, Claire
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    Promoting Scholarly Lines of Inquiry in Pharmacy Education Through Idea Papers and Case Study Reports
    (University of Minnesota, College of Pharmacy, 2014) Janke, Kristin K.; Kolar, Claire
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    Assessment of Asthma Inhaler Technique in Two Community Pharmacies
    (University of Minnesota, College of Pharmacy, 2014) Farabaugh, Nicole; McMillan, Ashlee; Garofoli, Gretchen
    Objectives: To 1) assess inhaler technique in patients with asthma who present to a community pharmacy and 2) determine if patients find it desirable to have further inhaler education from pharmacists. Methods: Participants were recruited when picking up their inhalers at either one chain or one independent pharmacy from May 2012 to December 2012. Any person 18 years of age or older, diagnosed with asthma, and currently prescribed an inhaler was eligible for inclusion in the study. Those who voluntarily agreed to participate were provided a written survey to evaluate current inhaler usage and past education from pharmacists. Participants were then asked to demonstrate how they currently operate their inhalers and observations regarding technique were recorded. Participants were then educated on what improvements could be made in their technique, if applicable. Results: A total of 31 surveys were completed for this study, of which only 3(9.6%) of the respondents were observed to be using their inhalers properly; however 18(58%) rated their technique as a 5 out of 5 on a Likert scale with 5 being the best. Almost all respondents (96.7%) classified their inhalers as “easy” or “very easy” to use, and 13 (41.9%) would prefer more education from pharmacists regarding their inhalers. Conclusion: The results of this study identified a significant need for patients to be educated on proper inhaler technique. It also revealed a high patient preference for pharmacists to offer additional education to patients using asthma inhalers upon initiation of inhaler therapy and with inhaler refills.
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    Incorporating a Continuing Professional Development Process into Residency Training
    (University of Minnesota, College of Pharmacy, 2014) Tofade, Toyin; Scolaro, Kelly L.; Bjerke, Lina; Crum, Meghan; Ferreri, Stefanie P.
    Continuing Professional development (CPD) has been defined as a “self-directed, ongoing, systematic and outcomes-focused approach to learning and professional development.” CPD is an important process that can be used to achieve a habit of lifelong learning and competence in the profession. The CPD process includes 5 steps – reflect, plan, act, evaluate and document. It has been postulated that introducing CPD early in a pharmacist's career encourages the development of life-long learning habits. Pharmacy residents are an ideal cohort to implement CPD into their program, since their accrediting body, the American Society of Health System Pharmacists (ASHP) already encourages the use of deliberate goal identification and evaluation throughout the resident’s training. We describe here the process of integrating a continuing professional development (CPD) model into a residency teaching certificate program, subsequent lessons learned and recommendations for the future.