Volume 02, Number 3, 2011

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    Chemical Stability of Hydrocortisone in Topical Preparation in Proprietary VersaProTM Cream Base
    (University of Minnesota, College of Pharmacy, 2011) Sarkar, Arindam Basu; Dudley, Richard; Melethil, Srikumaran; Speidel, Jonathon; Bhatt, Gopalkumar Markandakumar
    The United States Pharmacopeia-National Formulary (USP-NF) suggests beyond use dating ((BUD) for compounded topical preparations containing active pharmaceutical ingredients (API) [1]. The beyond the use dates of the preparations are based on the conservative and empirical guidelines of USP 795. Hydrocortisone (HC) content compounded in the VersaPro™ base cream was quantified using a HPLC method at time zero and after 30 and 60 days of storage at both room temperature and 4℃. The analysis suggests that the compounded preparations retain > 95% of the stated initial potency of HC regardless of storage conditions. Thus HC creams prepared in VersaPro™ cream base can be safely assigned a beyond the use date of two months when stored at room temperature.
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    Advancing Pharmacy Practice Through Social Theory
    (University of Minnesota, College of Pharmacy, 2011) Rovers, John
    Although there is a substantial role for social theory in explaining patients’ health behaviors, it does not appear that pharmacists commonly use such theories to provide patient care. This paper attempts to demonstrate an explicit link between social theory and pharmacy practice. The theory of structure and agency and the practice problem of poor medication adherence (MA) in patients with HIV/AIDS are used as exemplars to illustrate such a link. Factors influencing MA were identified from qualitative studies of adherence in patients with HIV/AIDS. All factors identified were stratified into one of four categories: agency related factors that facilitate MA; agency related factors that are barriers to MA; structural factors that facilitate MA; structural factors that are barriers to MA. Stratifying MA in this manner allows pharmacists to identify clinical interventions that are targeted towards the specific cause of MA problems.
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    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, Kathleen
    Chemotherapy-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.
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    Association Between Student Loan Debt on Graduation, Demographic Characteristics and Initial Choice of Practice Setting of Pharmacists
    (University of Minnesota, College of Pharmacy, 2011) Yusuf, Akeem A.; Schommer, Jon C.; Mott, David A.; Doucette, William R.; Gaither, Caroline A.; Kreling, David H.
    Objectives: (1) To examine trends in level of student loan indebtedness for groups of pharmacists that were first licensed between 1980 and 2006; (2) To examine if demographic variables are associated with level of student loan indebtedness; (3) To examine the association between student loan debt and choice of practice setting while controlling for demographic variables. Methods: Data for this study were collected from a national random sample of 3,000 pharmacists using a self administered survey. Descriptive statistics were used to examine trends in level of indebtedness. The relationships between level of indebtedness, demographic variables and practice setting choice were examined using Chi-square statistics. Multinomial logistic regression was used to determine the independent association of student loan debt and choice of practice setting while controlling for demographic variables. Results: The proportion of licensed pharmacists reporting student loan debt after graduation, and the mean amount of debt incurred increased between 1980 and 2006. Non-white pharmacists incurred debt at a higher proportion compared to white, and they also incurred significantly higher levels of debt. A lower level of indebtedness was associated with choosing independent practice over chain practice. Conclusions: Student loan indebtedness has been increasing over time, especially for non-white pharmacy students. Future research should be done to examine other factors that might influence student debt load, work contributions and choice of practice settings. The affordability of pharmacy education for students of color and how salaries may or may not help off-set these costs also should be examined closely.
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    Older Adult Perceptions of a Self-reported Medication Risk Questionaire: A Focus Group Study
    (University of Minnesota, College of Pharmacy, 2011) Witry, Matthew J.; Chang, Elizabeth H.; Mormann, Megan M.; Doucette, William R.; Newland, Brand A.
    Background: Medication therapy management (MTM) has been shown to resolve medication-related problems and decrease health care expenses. Public and private health insurers, providers, and other stakeholders are looking for ways to involve patients in the MTM process. One option is to engage patients through the use of a medication risk questionnaire. Objective: To investigate older adults’ perceptions of completing a medication risk questionnaire and receiving a rating of their risk for medication-related problems. Methods: Four, 75 to 90 minute focus groups were conducted using a semi-structured interview guide and copies of a medication risk questionnaire to collect qualitative data from 36 community dwelling older adults in Iowa, USA. Sessions were audio-recorded, transcribed, and analyzed thematically using an iterative process. Results: The thematic analysis yielded a general theme of comprehensive medication reviews, and two themes on the medication risk questionnaire: “process and items” and “risk category reactions.” Overall, participants were unfamiliar with pharmacist services beyond counseling. They were open to the questionnaire, but suggested it would be more useful as a topic for discussion with a provider than to screen patients. Despite their medication risk rating, most did not express interest in seeking a comprehensive medication review based on the result of the questionnaire as they considered themselves at low risk for problems. Conclusions: Using a medication risk questionnaire as a topic for discussion could provide health insurance plans or providers an opportunity to increase beneficiary familiarity with MTM. These beneficiary perspectives may be useful to health plan administrators and MTM providers as they pursue new ways to involve patients in the medication management process.
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    Patient And phaRmacit Telephonic Encounters (PARTE) in an Underserved Rural Population with Asthma: Methods and Rationale
    (University of Minnesota, College of Pharmacy, 2011) Young, Henry N.; Havican, S. Nadra; Chewning, Betty A.; Sorkness, Christine A.; Ruppel, Xin; Griesbach, Sara
    Purpose: Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described. Summary: In a randomized controlled trial (RCT), the Patient And phaRmacist Telephonic Encounters (PARTE) project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center. Ninety-eight participants have been randomized to either standard care or the intervention group who received consultation and direct feedback from pharmacists via telephone regarding their asthma self-management and medication use. Pharmacists used a counseling framework that incorporates the Indian Health Services 3 Prime Questions and the RIM Technique (Recognition, Identification, and Management) for managing medication use problems. Pharmacists encouraged patients to be active partners in the decision-making process to identify and address the underlying cause of medication use problems. Uniquely, this trial collected process and summative data using qualitative and quantitative approaches. Pharmacists’ training, the fidelity and quality of pharmacists’ service delivery, and short term patient outcomes are being evaluated. This evaluation will improve our ability to address research challenges and intervention barriers, refine staff training, explore patient perspectives, and evaluate measures’ power to provide preliminary patient outcome findings. Conclusion: A mixed method evaluation of a structured pharmacist intervention has the potential to offer insights regarding staff training, service fidelity and short term outcomes using quantitative and qualitative data in an RCT. Results will provide evidence regarding the feasibility and quality of carrying out the study and service delivery from the multiple perspectives of participants, clinicians, and researchers.
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    Community Pharmacy Marketing: Strategies for Success
    (University of Minnesota, College of Pharmacy, 2011) Wood, Kristina D.; Offenberger, Megan; Mehta, Bella H.; Rodis, Jennifer L.
    Purpose: As community pharmacies are implementing increasingly more clinical services they are faced with a new challenge of marketing these services. This article discusses The Ohio State University College of Pharmacy Clinical Partners Program’s (Clinical Partners) experiences in marketing clinical services to patients, barriers encountered through these experiences, and presents suggestions for future marketing of services. Experience: Clinical Partners developed two targeted marketing projects and evaluated impact on patient enrollment in services. In January 2008, the pharmacy ran a series of radio advertisements, newspaper print advertisements, and face to face marketing in the community with the focus of each being patient care services. During this project five individuals expressed interest in Clinical Partners’ services. Four indicated that they heard about Clinical Partners through the radio ad and one through the pharmacy website, though none chose to enroll in services. In 2009 Clinical Partners focused on marketing MTM in the form of a comprehensive medication review to current patients already enrolled in its anticoagulation management service. Following a three month period, 6 patients (8%) of the 71 patients receiving the marketing intervention chose to enroll in MTM. Four additional patients have enrolled in MTM since conclusion of the project. Discussion: These projects and a review of available literature revealed barriers that pharmacies encounter when marketing clinical services to patients in an outpatient setting including patients’ unawareness of the role a pharmacist can play outside dispensing medications, patients’ belief they do not need clinical services, and patients’ unwillingness to pay a pharmacist out of pocket for services. Future Implications: To overcome these identified challenges, community pharmacies should consider integration of marketing techniques such as tailoring marketing to a target population, forming and utilizing relationships with patients, and looking to past marketing successes in developing marketing plans. Pharmacists should also be adventurous in exploring new ways to promote pharmacy clinical services to find creative solutions to barriers encountered. As community pharmacies continue to grow the realm of clinical services offered to patients, it is important also to develop and implement marketing strategies to support the services and expansion of the profession so that these services can be embraced by patients and the health care community.
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    Providing Health Care Service-learning Experiences for IPPE Credit
    (University of Minnesota, College of Pharmacy, 2011) Bartelme, Kassandra M.; Ticcioni, Andrew J.; Janke, Kristin K.
    Service-learning (SL) provides an opportunity for students to learn personal and professional skills while providing a useful service to the community. Many pharmacy education programs use SL within their curriculum because of the benefits to the community, the faculty, the learning institution and the student(s). While SL has been used in schools/colleges of pharmacy for many years, SL that also fulfills IPPE requirements is newer. This paper seeks to promote the use of combined SL/IPPE experiences. It provides an example where students volunteered at federally qualified health centers and also reviews the ACPE Standards related to SL. Schools/colleges of pharmacy are encouraged to design mechanisms for students to participate in combined SL/IPPE experiences as part of their IPPE requirements.