Volume 04, Number 2, 2013

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Exploring a Laboratory Model of Pharmacogenetics as Applied to Clinical Decision Making
(University of Minnesota, College of Pharmacy, 2013) Kisor, David F.; Talbot, Jeffery N.; Stockert, Amy L.; Smith, Angela
Objective: To evaluate a pilot of a laboratory model for relating pharmacogenetics to clinical decision making. Case Study: This pilot was undertaken and evaluated to help determine if a pharmacogenetics laboratory should be included in the core Doctor of Pharmacy curriculum. The placement of the laboratory exercise in the curriculum was determined by identifying the point in the curriculum where the students had been introduced to the chemistry of deoxyribonucleic acid (DNA) as well as instructed on the chemistry of genetic variation. The laboratory included cytochrome P450 2C19 genotyping relative to the *2 variant. Twenty-four students served as the pilot group. Students provided buccal swabs as the source of DNA. Students stabilized the samples and were then provided instructions related to sample preparation, polymerase chain reaction, and gel electrophoresis. The results were reported as images of gels. Students used a reference gel image to compare their results to. Students then applied a dosing algorithm to make a “clinical decision” relative to clopidogrel use. Students were offered a post laboratory survey regarding attitudes toward the laboratory. Twenty-four students completed the laboratory with genotyping results being provided for 22 students (91.7%). Sixteen students were wild-type (*1/*1), while six students were heterozygous (*1/*2). Twenty-three students (96%) completed the post laboratory survey. All 23 agreed (6, 26.1%) or strongly agreed (17, 73.9%) that the laboratory “had relevance and value in the pharmacy curriculum”. Conclusion: The post pilot study survey exploring a laboratory model for pharmacogenetics related to clinical decision making indicated that such a laboratory would be viewed positively by students. This model may be adopted by colleges to expand pharmacogenetics education.
Effects of Medication Reconciliation Service Provided by Student Pharmacists in a Tertiary Care Emergency Department
(University of Minnesota, College of Pharmacy, 2013) Okere, Arinzechukwu Nkemdirim; Gessert, Charles; Renier, Collen; Swanoski, Michael
Objective: The primary objective of this case study was to evaluate the impact of a medication reconciliation service (MRS) provided by student pharmacists in an emergency department (ED). Methods: Eligible patients were assigned to two groups, MRS or non-MRS. Patients in the MRS group were seen by student pharmacists while the non-MRS group followed usual care. As part of the services provided by the student pharmacists, medication reconciliation was provided under the supervision of a clinical pharmacist. At the conclusion of their ED visit, patients were asked to complete a survey addressing knowledge of medications, confidence in medication taking and patient satisfaction. To evaluate the impact of provision of MRS by student pharmacists on readmission rates in the ED, the electronic health records of the institution were queried for subsequent inpatient hospitalizations and ED visits. Results: Based on the study, patients in MRS group were more likely to be satisfied with the education provided to them in the ED (p=0.016) and had greater confidence in taking their medications (p=0.03). Sixty days post ED visit MRS group readmissions were significantly lower compared to non-MRS group (P= 0.047). Conclusions: Students’ participation in the provision of medication reconciliation led to reduction of readmission in the tertiary care ED, improved patient satisfaction and confidence in medication use.
Consumer Reports - Best Buy Drugs’ Outreach Project in Minnesota
(University of Minnesota, College of Pharmacy, 2013) Schommer, Jon C.; Worley, Marcia M.; Schondelmeyer, Stephen
The objectives for this study were to apply four different approaches for disseminating Consumer Reports Best Buy Drugs (CR-BBD) information about effectiveness, safety, and cost to patients for therapeutic classes of medications that they were using and then (1) evaluate the usefulness of the information to participants and (2) document resultant information seeking. For the three approaches that utilized face-to-face contact (Approaches 2 through 4), we also compared them in terms of (1) number of medications reviewed per person, (2) availability of CR-BBD information per person, (3) changes that could be made for each person, and (4) potential/likely cost savings (per person per month). Finally, we described the availability of CR-BBD information for each participant categorized by the 19 therapeutic classes of medications for which there were Best Buy Drugs reports. Data were collected via self-administered surveys, in-person interviews, and telephone interviews. The results showed that almost all of the participants in the information sessions held for this study had at least one medication for which Best Buy Drug information was available with significant savings potential to be gained by using the recommended Best Buy Drug. Potential cost savings through the use of recommended Best Buy Drugs was $89.47 per person per month averaged over all participants (n = 172) and was $157.20 per person per month for those with savings over zero dollars (n = 98). Thirty-two percent of respondents to our evaluation survey reportedly sought more information from a physician and 30 percent sought more information from a pharmacist. We concluded that provision of information about effectiveness, safety, and cost to patients has the potential for achieving significant cost savings. Recommendations regarding (1) the timing of provision, (2) targeting of recipients and (3) traversing impediments are given.
Awareness of and Readiness for Medication Therapy Management Among Community Pharmacists in New York City: Results from a Focus Group
(University of Minnesota, College of Pharmacy, 2013) Arya, Vibhuti; Pinto, Sharrel; Khan, Tasmiya
For pharmacist-provided Medication Therapy Management (MTM) services to operate effectively and efficiently, pharmacists must understand the process of MTM delivery, assess the barriers and challenges in creating a sustainable MTM program, and realize the willingness and readiness of their colleagues to deliver such services. In order to assess feasibility of such services among high-risk neighborhoods in New York City (NYC), a focus group design was used to qualitatively assess pharmacists’ perceptions of MTM. Findings showed that reimbursement and allocation of resources were the most discussed challenges/barriers to the provision of pharmacist-provided MTM services. Overall, pharmacists were willing, but not yet ready, to provide MTM services on a large scale. Lack of understanding of MTM structure/process, reimbursement challenges, and the need for collaboration between providers were key components to pharmacists’ willingness to provide services. Additional training opportunities were deemed necessary for them to feel confident to conduct clinical services. Although pharmacists discussed several issues regarding MTM, they were still interested in participating and seeing how MTM would impact their community practice settings. Understanding these perceptions of pharmacists on MTM allowed us to better understand and assess ways for continuous quality improvement of services that will enhance patient care.
Attitudes of Iraqi society towards the role of community pharmacists
(University of Minnesota, College of Pharmacy, 2013) Ibrahim, Inas R.; Al Tukmagi, Haydar F.; Wayyes, Abdulrasoul
Objectives: The main aims of this study were to assess society’s use of community pharmacies; evaluate attitudes towards the role of the community pharmacist; and describe required pharmacist characteristics and future services. Study design: A cross-sectional survey with a stratified sampling technique. Methods: A self-administered, validated, questionnaire was distributed to 500 consumers in attendance at 50 community pharmacies in Baghdad, Iraq. Data were gathered from January to April 2012. Mann-Whitney and Kruskal-Wallis tests were performed to test for statistical differences among the study variables. Further analysis through the Chi-square test and logistic regression was completed to assess the predictors of society’s attitudes. Results: Twenty-six percent of respondents visited their community pharmacies at least once per week and an additional 65% reported visiting their pharmacy at least once per month. Fifty-five percent of respondents listed the community pharmacist as the first person they would contact in case of any drug-related problem. However, the pharmacist’s role was under-appreciated by the majority of respondents (79.8%). These attitudes varied significantly with regard to the demographic characteristics of respondents. Logistic regression analysis showed that gender and age were the influential predictors of favourable versus non-favourable attitudes towards the role of pharmacist. Conclusions: The use of community pharmacies in Iraq was characterized by frequent visits to purchase medicines. Selection of the pharmacy primarily depended on its location. Overall, an under-appreciation of the professional performance of pharmacists was predominant. Raising public awareness towards the important role of community pharmacists in providing public health is warranted.
Drug shortage management in Alabama hospital pharmacies
(University of Minnesota, College of Pharmacy, 2013) Holmes III, Oliver W; Hughes, Peter J.
Purpose: The purpose of this study is to identify effective strategies used by Alabama hospitals to manage drug shortages. Moreover, this study aims to determine if there are any relationships among hospital size, utilization of a standard policy for drug shortage management and perceived usefulness of standard procedures for drug shortages. Methods: A paper survey was mailed to 129 hospital pharmacies in Alabama (per the Alabama Hospital Association directory). The survey consisted of 5 demographic questions, questions involving perception of current medication shortages, sources of information about shorted drugs, and frequency of discussion at P&T committee meetings. Most importantly, the survey contained questions about the use of a standard policy for handling drug shortages, the effectiveness of the policy if one is used, and an open-ended question asking the recipient to describe the policy being used. Results: A response rate of 55% was achieved as 71 surveys were completed and returned. Approximately 70% of the survey respondents described the current drug shortage issue as a top priority in their pharmacy department. The pharmacy distributor served as the primary source of information regarding drug shortages for 45% of the facilities. There is a direct relationship between size of hospital and likelihood of utilization of a standard policy or procedure for drug shortage management among the sample. The smaller facilities of the sample perceived their management strategies as effective more frequently than the larger hospitals. Conclusion: Common components of effective management strategies included extensive communication of shortage details and the ability to locate alternative products. The use of portable technology (e.g., Smart phones and tablets) along with mobile applications may emerge as popular means for communicating drug product shortage news and updates within a facility or healthcare system.
Transitions in Care: Medication Reconciliation in the Community Pharmacy Setting After Discharge
(University of Minnesota, College of Pharmacy, 2013) Freund, Jeff E.; Martin, Beth A.; Kieser, Mara A.; Williams, Staci M.; Sutter, Susan L.
Objective: To assess the feasibility of a workflow process in which pharmacists in an independent community pharmacy group conduct medication reconciliation for patients undergoing transitions in care. Methods: Three workflow changes were made to improve the medication reconciliation process in a group of three independent community pharmacies. Analysis of the process included workflow steps performed by pharmacy staff, pharmacist barriers encountered during the medication reconciliation process, number of medication discrepancies identified, and pharmacist comfort level while performing each medication reconciliation service. Key Findings: Sixty patient medication reconciliation services met the inclusion criteria for the study. Pharmacists were involved in all steps associated with the medication reconciliation workflow, and were the sole performer in four of the steps: verifying discharge medications with the pharmacy medication profile, resolving discrepancies, contacting the prescriber, and providing patient counseling. Pharmacists were least involved in entering medications into the pharmacy management system, performing that workflow step 13% of the time. The most common barriers were the absence of a discharge medication list (24%) and patient not present during consultation (11%). A total of 231 medication discrepancies were identified, with an average of 3.85 medication discrepancies per discharge. Pharmacists’ comfort level performing medication reconciliation improved through the 13 weeks of the study. Conclusions: These findings suggest that medication reconciliation for patients discharged from hospitals and long term care facilities can be successfully performed in an independent community pharmacy setting. Because many medication discrepancies were identified during this transition of care, it is highly valuable for community pharmacists to perform medication reconciliation services.