Volume 02, Number 1, 2011

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    Pharmaceutical systematics: Description and preliminary investigation of an alternative method for structuring drug information
    (University of Minnesota, College of Pharmacy, 2011) Kiersma, Mary E.; Chen, Aleda M. H.; Villa, Kristin R.; Shepler, Brian M.; Murawski, Matthew M.
    Objectives: To identify the 30 most common adverse drug events or reactions (ADE/ADRs) within the top 200 medications: (1) by raw incidence, (2) weighted by prescription volume, (3) and weighted by retail dollars. Methods: The Pharmacy Times Top 200 Medications (as ranked by prescription volume) was utilized to identify the top 200 medications in 2008. The ADE/ADRs for each medication were obtained from Facts and Comparisons, Micromedex, and Lexi-Comp and entered into a database. These ADE/ADRs were compiled and summed, identifying the number of times each appeared. These then were ranked to identify the 30 most common ADE/ADRs. The actual prescription volume and total retail dollars for each medication were obtained and listed next to each medication’s ADE/ADR. The incidence of each ADE/ADR then was weighted by actual prescription volume and retail dollars to determine the top 30 most common ADE/ADRs. Results: Initial evaluation resulted in 9829 individual ADE/ADRs and summed into 1477 distinct ADE/ADRs, after adjusting for interchangeable terminology. Examples of the 30 most common ADE/ADRs (raw incidence) included: dizziness/vertigo, headache, nausea, vomiting, and diarrhea/loose stools. The list remained the same after weighting by actual prescription volume. After weighting by retail dollars, the order of ADE/ADRs changed slightly. Conclusion: Knowledge of ADE/ADRs is important for pharmacists in all healthcare settings. Consolidating ADE/ADRs for medications may enable pharmacists to recall the most common side effects and aid in earlier identification of ADE/ADRs, which may positively impact patient safety across practice settings.
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    Over-the-Counter Medication Use, Perceived Safety, and Decision-Making Behaviors in Pregnant Women
    (University of Minnesota, College of Pharmacy, 2011) Kline, Katie L.; Westberg, Sarah M.
    The purpose of this study was to determine which over-the-counter (OTC) medications women are using during pregnancy, and to assess patients’ perceived safety of these medications. In addition, the decision-making process utilized by pregnant women when choosing OTC drug therapy was explored, including sources of information and recommendation. The subjects included pregnant women 18 years and older. Subjects were solicited as a convenience sample by providing surveys in two urban women’s clinic waiting rooms. Of the 61 respondents, 96.3% had used an OTC medication, herbal, or vitamin during their current pregnancy. The most common products included prenatal vitamins, acetaminophen, cough drops, antacids, calcium, vitamin D, and DHA. The majority of women surveyed regarded over-the-counter medications, vitamins, and herbals as “safe, but would talk to a healthcare professional before using.” The most utilized sources of drug information during pregnancy were a physician (68.9%), midwife (55.7%), and the Internet (44.3%). There were an equal number of respondents obtaining general OTC information from a pharmacist as from their family and friends (26.2%). Almost all subjects had used an over-the-counter medication during their pregnancy and the majority considered OTCs safe after first consulting a healthcare professional. Although a high percentage of subjects have obtained their information and recommendations from healthcare professionals, a very small proportion of subjects had utilized a pharmacist as a resource. Being drug experts and easily accessible members of the healthcare team, pharmacists have a responsibility to aid the obstetric population in the appropriate and safe use of over-the-counter drugs, vitamins, and herbals during pregnancy.
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    A Description of Medication Therapy Management Services in Minnesota
    (University of Minnesota, College of Pharmacy, 2011) Digatono, Amie Jo
    Objective: To describe Medication Therapy Management (MTM) services in Minnesota, quantifying how many patient encounters occur per week and compiling provider and practice site characteristics. Design: Cross‐sectional study. Setting: Minnesota practice sites surveyed in June and July 2010. Participants: MTM providers in Minnesota who are registered users of the Assurance® documentation system or are members of the Minnesota Pharmacists Association MTM Academy. Intervention: Self‐administered online questionnaire completed by study participants. Main Outcome Measures: The number of patient encounters per week, practice site location, practitioner length of time as a MTM service provider, and the motivating factors for providing direct patient care services. Results: There were 56 respondents, reporting a median of 5 MTM patient encounters per week (range 0 to 35) and a median length of service of 4 years (range <1 to 15). Clinic‐based practices were reported by 66% of providers and community pharmacy‐based practices by 30%. Eighty‐five percent practice in an urban setting, 9% in a large rural town and 6% in a small rural town. Nearly half (46%) of providers are the sole practitioner at their site. The most commonly cited motivation for providing direct patient care services was to improve patient outcomes. Conclusion: MTM service providers in Minnesota were more likely to report practicing in an urban area and in a clinic. Many practices were low‐volume or newly established, with half of all respondents reporting 5 or fewer MTM patient encounters per week and a length of service of four years or less.
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    Medication adherence and its relationship to the therapeutic alliance: Results from an innovative pilot study within a community pharmacy MTM practice
    (University of Minnesota, College of Pharmacy, 2011) Pringle, Janice; Melczak, Michael; Aldridge, Arnie; Snyder, Margie; Smith, Randall
    Objectives: To determine whether patients who received Medication Therapy Management (MTM) from community pharmacists using a brief scale to measure Therapeutic Alliance (i.e., MTM + TA) would show better medication adherence than patients who received MTM without use of the TA scale (MTM only). Design: Quasi-experimental, using a direct intervention group (MTM + TA) and a comparison group of randomly selected claims records from patients who received only the MTM service (MTM only). We used a doubly robust propensity score approach to estimate the average effect of therapeutic alliance on medication adherence. The analysis was limited to the following broad medication categories: antihypertensives, antidiabetic agents, and antihyperlipidemics. Setting: The direct intervention group included patients receiving MTM services from pharmacists in a community pharmacy chain setting. Participants: After matching with claims data, the direct intervention group was n=117, with an average age of 76.4. The comparison group was n=146, with an average age of 76.2. Intervention: Administration of two brief scales designed to measure general health outcomes and TA within the context of MTM (with focus on TA scale administration). Main Outcome Measures Proportion of Days Covered (PDC) and PDC80. Results: Using the therapeutic alliance scales in the context of community pharmacist-provided MTM was associated with a 3.1 percentage point increase in patients’ overall PDC (p<.001) and an increase of 4.6 percentage points in PDC80 (p=.02) as compared to patients receiving MTM without use of the therapeutic alliance scales. Conclusion: Measuring therapeutic alliance in the context of MTM is associated with improved medication adherence and represents one strategy for enhancing the effectiveness of MTM encounters. Furthermore, administration of the therapeutic alliance scales used very little time; therefore it is likely feasible for pharmacists to routinely use the scales in their practice.
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    African-American and Latina Women Seeking Public Health Services: Cultural Beliefs regarding Pregnancy, including Medication-taking Behavior
    (University of Minnesota, College of Pharmacy, 2011) Sanchez, Luz Dalia; Rowles, Joie; Dube, David
    Objective: to describe cultural beliefs and medication-taking-behavior about pregnancy in African-American and Latina women. Design: qualitative study using phenomenological methodology; face-to-face, semi structured interviews and focus group. Thematic analysis was done to obtain themes consistent with the research objective. Setting: Maricopa County, Arizona, Department of Public-health Programs, November 2008 through April 2009. Participants: women seeking public-health services in the greater Phoenix, Arizona. Results: fifteen adult women representing two ethnic groups (seven African-Americans and eight Latinas) participated. Themes derived from the interview data included: “The Dilemma: To Become or Not to Become Pregnant;” “The Ideal Stress-free World: Support System;” “Changing Worlds: Wanting Dependency;” and “The Health care System: Disconnection from Pregnancy to Postpartum.” Conclusions: based on the cultural themes: 1. pregnancies were not planned; 2. healthy life-style changes were not likely to occur during pregnancy; 3. basic facts about the biology of sexual intercourse and pregnancy were not understood, and there was no usage of any preconceptional or prenatal medications; and 4. professional health care was not desired or considered necessary (except during delivery). These cultural beliefs can contribute to negative birth outcomes, and need to be considered by pharmacists and other health-care providers. The information gained from this study can guide the implementation of educational programs developed by pharmacists that are more sensitive to the cultural beliefs and points of view of these particular women. Such programs would thus be more likely to be favorably received and utilized.
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    Academic Success and Initial Labor Market Outcomes for Pharmacy Graduates
    (University of Minnesota, College of Pharmacy, 2011) Murphy, Sean; Naughton, Cynthia; Friesner, Dan
    Purpose: This study examines the relationship between academic success and labor market outcomes among graduating pharmacy students. Unlike previous studies, this paper characterizes labor market outcome not only as an individual’s starting salary, but also whether or not the student had a position secured at the time of graduation, whether or not a signing bonus was received, and the setting in which (s)he will practice. Methods: A standard exit survey was administered to graduating Doctor of Pharmacy students at a Midwestern, public university within two weeks of graduation. The relationship between academic success and initial labor market outcome was assessed using cross-tabulations, chi-square and Fisher exact tests. Results: There were no significant relationships between grade point averages and signing bonuses, starting salaries or employment offers. Students with higher grade point averages were less likely to work in chain community pharmacies, and more likely to work in a hospital or other health-system setting. Conclusions: The relationships between academic and direct measures of labor market outcomes (salary and bonuses) were not necessarily positive, as standard economic theory predicts. Rather, the relationship is indirect, as it appears that students with greater academic success obtained employment in more clinical settings, which carry a different mix of pecuniary and non-pecuniary benefits.
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    Risky Business
    (University of Minnesota, College of Pharmacy, 2011) Katwaru, Miranda; Tobin, Matthew; Arya, Vibhuti
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    (University of Minnesota, College of Pharmacy, 2011) Uden, Donald L.; Schommer, Jon C.
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    What’s Past is Prologue: The Pharmaceutical Syllabus of 1910
    (University of Minnesota, College of Pharmacy, 2011) Schommer, Jon C.; Hadsall, Ronald S.; Anderson, Lowell J.
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    Comparison of Traditional Versus Evidence-Based Journal Club Formats
    (University of Minnesota, College of Pharmacy, 2011) Packard, Kathleen; Herink, Megan; Lenz, Thomas L.
    Purpose: The objective of the study was to compare a traditionally structured journal club with an evidence based structured journal club during an advanced clinical pharmacy rotation and to determine the best utilization that aligns with recent changes to the pharmacy school accreditation standards. Methods: The study included 21 students who completed journal club utilizing the traditional journal club format and 24 students who utilized an evidence based journal club format. Background characteristics, student reported beliefs, and mean critical evaluation skills scores were evaluated and compared in each group. Results: There were no statistically significant differences between the two cohorts in mean overall percentage grade for the activity. Students in the traditional cohort received significantly higher grades for the Study Analysis and Critique section (90.97 + 12.18 versus 81.25 + 11.18, P=0.01) as well as for the Preparedness section (96.11 + 8.03 versus 85.0 + 17.13, P=0.002). Students in the evidence based cohort received statistically superior grades for the Presentation Skills section (96.43 + 6.39 versus 82.47 + 14.12, P=0.0004). Conclusion: An evidence based journal club is a reasonable and effective alternative to the traditionally structured journal club when the primary objective is to assist students in understanding evidence based concepts and to apply current literature to clinical practice.
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    The Pharm.D. in Pakistan: A Curricular Innovation in Health Systems Instruction
    (University of Minnesota, College of Pharmacy, 2011) Khalid, Shaukat; Fazal
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    Development and Implementation of an Academic-Community Partnership to Enhance Care among Homeless Persons
    (University of Minnesota, College of Pharmacy, 2011) Gatewood, Sharon B.S.; Moczygemba, Leticia R.; Alexander, Akash J.; Osborn, Robert D.; Reynolds-Cane, Dianne L.; Matzke, Gary R.; Goode, Jean-Venable R.
    An academic-community partnership between a Health Care for the Homeless (HCH) clinic and a school of pharmacy was created in 2005 to provide medication education and identify medication related problems. The urban community based HCH clinic in the Richmond, VA area provides primary health care to the homeless, uninsured and underinsured. The center also offers eye care, dental care, mental health and psychiatric care, substance abuse services, case management, laundry and shower facilities, and mail services at no charge to those in need. Pharmacist services are provided in the mental health and medical clinics. A satisfaction survey showed that the providers and staff (n = 13) in the clinic were very satisfied with the integration of pharmacist services. The quality and safety of medication use has improved as a result of the academic-community collaborative. Education and research initiatives have also resulted from the collaborative. This manuscript describes the implementation, outcomes and benefits of the partnership for both the HCH clinic and the school of pharmacy.
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    Sharing Community Engagement in Pharmacy – An Invitation
    (University of Minnesota, College of Pharmacy, 2011) Sorensen, Todd D.; Davis, Robin L.; Balidemaj, Festina