Volume 05, Number 1, 2014

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    Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention
    (University of Minnesota, College of Pharmacy, 2014) Di Pietro, Natalie A.; Bright, David R.
    As medication therapy management (MTM) continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.
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    Needle free injection technology - An overview
    (University of Minnesota, College of Pharmacy, 2014) Kale, Tejaswi R.; Momin, Munira
    Needle free injection technology was developed to reduce the number of needle stick accidents and associated problems. A comprehensive literature review was completed regarding needle free injection technology and its applications, advantages over needle injections, their components and types such as powder injection, liquid injection, depot or projectile injection. This review describes needle free injection technology involving the generation of force by using compressed gas upon actuation in order to deliver a drug at very high speed through a nozzle. This review also describes injection methods that use a spring load jet injector, battery powdered jet injector, and gas powdered jet injector. An overview of marketed products, recent trends and other needleless drug delivery systems is given. Needle free injection technology is growing and has the potential to make the administration of medicine more efficient, safe and convenient.
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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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    Promotion of ethical principles in provision of medication therapy management services
    (University of Minnesota, College of Pharmacy, 2014) Kelling, Sarah E.; Aultman, Julie M.
    As pharmacists move toward more patient-centered care through medication therapy management (MTM), important issues and conflicts may arise within the therapeutic relationship, requiring pharmacists to use ethical knowledge and skills toward conflict-resolution. The purpose of this paper is to explore practical strategies that pharmacists and other champions of MTM may utilize to support the ethical principles of autonomy, veracity, nonmaleficence, beneficence, and justice, along with an ethic of care during the provision of MTM services. With a deeper understanding of ethical principles and the Code of Ethics for Pharmacists, pharmacists may be more prepared to make difficult ethical decisions, and ultimately, guide better patient care.
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    Examining the Impact of a Pharmacists Postpartum Counseling Service; Evidence from a University Hospital
    (University of Minnesota, College of Pharmacy, 2014) Schatz, Kristina; Chapman, Jennifer; Chang, Jongwha
    Purpose: To describe a pharmacist’s counseling service pertaining to methods of contraception on the postpartum unit of a university hospital and to evaluate the number of postpartum patients who desire information on contraception with the demographics of age, public or private insurance, and whether the patient was English or Spanish-speaking. Methods: Retrospective cohort data analysis of postpartum women who received the option of counseling by a pharmacist or pharmacy intern at a university hospital over a year and 7 month period. There were 2,048 cases included for this study. The total number of patients who wanted information as well as pharmacist preparation time and counseling time were also noted. Results: Patients who were interested in a hormonal contraception method were 3 times more likely to desire counseling compared with patients who declined information (p<0.05). Also, patients who wanted an implantable form of contraception were 8 times more likely to desire information compared with patients who declined counseling (p<0.05). Patients in the age range of 18-25, 26-30, and 31-45 years were less likely (56%, 64%, & 65%) to want counseling compared with the age range of 12-17 years (all p<0.05). Lastly, patients who spoke Spanish were 3 times more likely to have been counseled compared with non-Spanish speaking patients. The number of postpartum patients counseled on different contraception methods was 1,546 versus 699 patients who declined counseling. Total pharmacist preparation time totaled 160.95 hours, while total patient counseling time totaled 204.55 hours. Conclusion: Overall, postpartum women who chose to be counseled by a pharmacist were considering either a hormonal or implantable method of contraception, were younger than the age of 17 and were Spanish speaking. The average amount of pharmacist preparation time spent was 4.3 minutes per patient and actual counseling time on average was 5.5 minutes per patient.
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    On house calls, healthcare, and hope: one student’s perspective
    (University of Minnesota, College of Pharmacy, 2014) Shelquist, Ryan; Greene, Elisa
    Healthcare providers spend years studying pathophysiology and therapeutics, often neglecting to consider the whole picture of influences on a person’s health. House calls are a beneficial tool in that they provide the opportunity for trainees to experience these concepts firsthand, often opening student eyes to suffering, poverty, and unexpectedly, hope. Exposure to this broader perspective may empower health care providers to see beyond the limitations of disease and medication, into deeper issues that affect patient health.
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    Identifying medication-related needs of HIV patients: foundation for community pharmacist-based services
    (University of Minnesota, College of Pharmacy, 2014) Kauffman, Yardlee; Barkowitz, Elana; Cerussi, Nicole; Pringle, Jan; McGivney, Melissa
    Background: Patients living with HIV/AIDS have complex medication regimens. Pharmacists within community pharmacy settings can have a role managing patients living with HIV/AIDS. Patients’ perspectives surrounding implementation about community pharmacist-based services is needed as limited information is available. Objective: To identify medication-related needs of HIV-infected patients who receive prescriptions from a community pharmacy. To determine patient perspectives and knowledge of community pharmacist-based services. Methods: A qualitative research study involving in-depth, semi-structured interviews with patients was conducted. Inclusion criteria included: HIV positive men and women at least 18 years of age who receive care at a HIV clinic, currently take medication(s) and use a community pharmacy for all prescription fills. Patients were recruited from one urban and one rural health center. Patients answered questions about their perceptions and knowledge about the role and value of pharmacy services and completed a demographic survey. The recordings of the interviews were transcribed verbatim and were analyzed using principles of Grounded Theory. Results: Twenty-nine interviews were conducted: 15 participants from the urban site and 14 from the rural site. Five main themes emerged including: patients experience ongoing and varying medication-related needs; patients desire a pharmacist who is caring, knowledgeable and integrated with health care providers; patients expect ready access to drug therapy; patients value an individualized patient encounter, and patients need to be informed that a pharmacist-service exists. Conclusion: Patients with HIV value individualized and personal encounters with pharmacists at time intervals that are convenient for the patient. Patients felt that a one-on-one encounter with a pharmacist would be most valuable when initiating or modifying medication therapy. These patient perspectives can be useful for pharmacists and pharmacies interested in providing advanced care to patients with HIV.
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    Assessment of Community Pharmacists Willingness and Barriers of Medication Therapy Management (MTM) focused on Pain Management and Mental Health
    (University of Minnesota, College of Pharmacy, 2014) Keller, Megan E.; Bright, David R.; Sullivan, Donald L.; Cornelius, Doug C.
    Objectives: To determine the willingness and barriers of community pharmacists to provide pain management and depression MTM services. Methods: An anonymous, self-administered survey was distributed electronically to 350 licensed pharmacists in a supermarket pharmacy chain. The survey consisted of a 40 question, Likert-type scale, where strongly disagree was assigned a value of one and strongly agree a value of seven. Constructs measured included: MTM interest, comfort with MTM, confidence with appropriate medication use and adjustment, educational needs, training required, time constraints, and work-related factors. Demographic data was also collected. Results: A total of 186 (53%) community pharmacists completed the survey. These pharmacists worked in an environment where MTM was currently being provided. Ninety percent of respondents averaged 0-5 MTM sessions per 4 week period. Pharmacists agreed that patients would benefit from MTM focused on pain (median 6 IR[5-7]) and/or depression (median 6 IR[5-7]) and agreed pharmacists can have positive interventions in these situations (pain: median 6 IR[5-7]; depression: median 6 IR[5-7]). Pharmacists surveyed were interested in continuing education and live presentation as preferred methods to improve knowledge of pain management and depression. Conclusion: Pharmacists are interested in and believe patients would benefit from MTM specifically for pain management and depression. Barriers to MTM focused on pain and depression were pharmacist training and workflow issues with the MTM process.
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    The Development of a Community-Based, Pharmacist-Provided Falls Prevention MTM Intervention for Older Adults: Relationship Building, Methods, and Rationale
    (University of Minnesota, College of Pharmacy, 2014) Mott, David A.; Martin, Beth; Breslow, Robert; Michaels, Barb; Kirchner, Jeff; Mahoney, Jane; Margolis, Amanda
    The objectives of this article are to discuss the process of community engagement experienced to plan and implement a pilot study of a pharmacist-provided MTM intervention focused on reducing the use of medications associated with falling, and to present the research methods that emerged from the community engagement process to evaluate the feasibility, acceptance, and preliminary impact of the intervention. Key lessons learned from the community engagement process also are presented and discussed. The relationship building and planning process took twelve months. The RE-AIM framework broadly guided the planning process since an overarching goal for the community partners was developing a program that could be implemented and sustained in the future. The planning phase focused on identifying research questions that were of most interest to the community partners, the population to study, the capacity of partners to perform activities, and process evaluation. Much of the planning phase was accomplished with face-to-face meetings. After all study processes, study materials, and data collection tools were developed, a focus group of older adults who represented the likely targets of the MTM intervention provided feedback related to the concept and process of the intervention. Nine key lessons were identified from the community engagement process. One key to successful community engagement is partners taking the time to educate each other about experiences, processes, and successes and failures. Additionally, partners must actively listen to each other to better understand barriers and facilitators that likely will impact the planning and implementation processes. Successful community engagement will be important to develop both formative and summative evaluation processes that will help to produce valid evidence about the effectiveness of pharmacists in modifying drug therapy and preventing falls as well as to promote the adoption and implementation of the intervention in other communities.
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    International Variations In Essential Medication Lists
    (University of Minnesota, College of Pharmacy, 2014) Tejani, Ali H.; Wertheimer, Albert
    Every nation in the world has established a National Medication Formulary to account for all the medications present in the country. Many countries follow the Essential Medication List provided by the World Health organization (WHO) when making their own National Medication Formulary. Our study looked at variations in the National Formularies when compared to the Essential Medication Lists. Different relationships such as missing and extra medications lists were formulated and the statistics analyzed. It was noted that on average most of the countries studied were lacking 47% of medications, and had 30% additional medications on their national formulary. Further studies need to be conducted as Essential Medications may be lacking, or harmful medications may be present in a country’s formulary leading to severe health problems.
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    Case Study: Developing, Implementing, and Evaluating a One-Day Leadership Conference to Foster Women’s Leadership in Healthcare
    (University of Minnesota, College of Pharmacy, 2014) Fierke, Kerry K.; Kading, Margarette L.
    Despite women increasingly entering the healthcare field, they still face barriers to advancing in leadership ranks within healthcare. To address the need for leadership development among women in healthcare, the Center for Leading Healthcare Change (CLHC) at the University of Minnesota College of Pharmacy piloted a one-day conference in November 2012 entitled “Women Impacting Healthcare: Decide to Make a Difference.” This conference utilized an interactive agenda: each speaker’s presentation was followed by hands-on leadership activities during which attendees developed their own personal leadership visions. Specific leadership activities were designed to build upon one another and help design a leadership pathway. All activities were consistent as they included personal reflection and interaction with others. Attendees were asked to complete two evaluations, one immediately at the conclusion of the conference, and another two-weeks post. The conference committee achieved the goal of delivering the conference objectives. As the Women Impacting Healthcare committee continues to look for ways to develop leaders in healthcare, the focus of future conferences will also evolve to include the needs of women currently in leadership roles, as well as ways women can grow into leadership roles.
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    Value of Online Medication Therapy Management Resources: Community Pharmacist Perspectives
    (University of Minnesota, College of Pharmacy, 2014) Doucette, William R.; Nguyen, Elaine; Zhang, Yiran; Pendergast, Jane F.; Chrischilles, Elizabeth A.; Farris, Karen B.; Frank, Jessica
    Objectives: To describe pharmacists’ attitudes toward and satisfaction with on-line training modules on MTM tools and tips for pharmacists and to characterize how useful the tools and concepts in the modules were to pharmacists when delivering MTM services. Methods: Researchers distributed a web-based survey to pharmacists who had viewed the training modules that had been posted onto the training web site of OutcomesMTM. The majority of survey questions consisted of a 6-point Likert scale. Questions assessed pharmacists’ opinions on the use of the tools. Information also was collected on implementing MTM tips, pharmacist demographics, and practice site characteristics. Results: Respondents rated the Tool to Improve Medications in the Elderly via Review (TIMER) and DRug Adherence Work-up (DRAW) tools favorably across multiple items. Many pharmacists integrated the MTM tips into their practices, and reported increased efficiency in their delivery of MTM services. Conclusion: Pharmacist training and tools such as the TIMER and DRAW tools plus MTM practice tips can assist pharmacists in providing MTM services to patients.