Volume 01, Number 1, 2010

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    Science, Innovation, and Innovation in the Science of Pharmacy
    (University of Minnesota, College of Pharmacy, 2010) Cline, Richard R.; Worley, Marcia M.; Westrick, Salisa C.; Schommer, Jon C.
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    Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management
    (University of Minnesota, College of Pharmacy, 2010) Branham, Ashley; Moose, Joseph; Ferreri, Stefanie
    Objective: To determine if pharmacist-provided medication therapy management (MTM) improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR). Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR). Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC) and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8). Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43). However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08) following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.
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    Implementation of a Pharmacist-Directed Cardiovascular Risk and Medication Management Program for Participants in a Construction Trade Benefit Trust Fund
    (University of Minnesota, College of Pharmacy, 2010) Liu, Yifei; McDonough, Randal P.; Carruthers, Kara M.; Doucette, William R.; Miller, Kathleen
    Objectives: (1) To report the results of a pharmacist-directed cardiovascular risk management program; and (2) to identify obstacles faced by the pharmacists in the program implementation. Methods: The collaborators in this study included two local unions, a health benefit consulting company, and a community pharmacy. A total of 750 union workers with cardiovascular risk were informed about the cardiovascular risk management program. The program lasted six months, and the participation was voluntary. There were three group educational sessions with each session followed by a medication management service. A staff person of the health benefit consulting company and two pharmacists were interviewed via telephone. The interview questions were created according to the Gaps Model of Service Quality. The Gaps Model theorizes five gaps among consumer expectations, consumer perceptions, management perceptions of consumer expectations, service quality, service delivery, and external communications to consumers. The following data were collected: (1) types and quantity of drug therapy problems, (2) pharmacists’ recommendations and prescribers' response, (3) patients’ quality of life, disability days, and sick days, and (4) the experience of involved parties. Descriptive statistics were calculated. Results: Fifteen union workers participated in the program. For the participants, 35 drug-related problems were identified, with “need for additional therapy” and “dose too low” being the most common problems. To address these drug-related problems, pharmacists made 33 recommendations to prescribers, and prescribers accepted 55% of the recommendations. According to the interviews, there were three barriers faced by pharmacists to implement the program: lack of consensus about the recruitment, union workers’ unawareness of the program’s benefits, and limited support from the unions and the health benefit consulting company. Conclusions: It was difficult to recruit participants into the program. Clear agreement among collaborators on both the program’s benefits and the specific roles of each collaborator may be the key to successfully implement similar programs in the future.
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    Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative
    (University of Minnesota, College of Pharmacy, 2010) Westberg, Sarah M.; Beeksma, Kathrine
    Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic. Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation. Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.
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    Innovations in Pharmacy through Practice-Based Research
    (University of Minnesota, College of Pharmacy, 2010) Schommer, Jon C.; Brown, Lawrence M.; Doucette, William R.; Goode, Jean-Venable "Kelly" R.; Oliveira, Djenane Ramalho de
    The overall purpose of this article is to serve as an invitation for submissions to the ‘Practice-Based Research’ section of INNOVATIONS in pharmacy. To provide background about this section of the journal, this paper describes: (1) the concept of innovations that we will apply, (2) the practice-based research domain, and (3) the use of practice-based research networks for this area of inquiry. We propose that uncertainty surrounding an innovation often will result in the postponement of the decision regarding its adoption until further evidence can be obtained. Such evidence often is gathered through considering the advice and experiences of opinion leaders and members of social systems who have adopted the innovation. We invite authors to present ideas, arguments, and evidence for innovations in pharmacy that arise out of practice-based research. We propose that this journal will be an excellent communication vehicle for providing convincing arguments and sound evidence in favor of innovations. Discourse regarding new ideas in such a format can further develop the ideas, create a critical mass of evidence, and be used for convincing others that the innovation should be adopted. We welcome submissions to the INNOVATIONS in pharmacy, PRACTICE-BASED RESEARCH content area that: (1) provide convincing arguments and sound evidence in favor of innovations for pharmacy, (2) are based upon practice-based research from case studies of single patients on one end of the continuum to findings from large populations of patients on the other end of the continuum, and/or (3) introduce innovations for practice-based research networks. We encourage articles from all perspectives and from all methods of inquiry.
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    Prescription drug brand Web sites: Guidance where none exists
    (University of Minnesota, College of Pharmacy, 2010) Glinert, Lewis
    This paper applies insights from linguistics and discourse analysis to prescription drug brand Web sites, with special reference to the 100 top-selling drugs. Such sites give the outward appearance of being a place to go for straightforward information about a specific brand. In reality, they present a confused mix of brand information, health information and hype, muddled organization, and poor indication of authority, creating an imbalance between benefit and risk content. In so doing, they breach the letter and spirit of the regulations governing direct-to-consumer advertising, which the FDA has by default applied to such Web sites but which were not designed for this special type of discourse. The many communicative difficulties proven to be caused by Web sites in general, in particular for the elderly and less literate, also pose ethical problems. A rethinking of the verbal and visual design of these drug sites is needed -- and new regulatory guidance, for which this paper offers recommendations. At stake is not just the quality of health information at brand drug sites but also their credibility.
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    Pharmacist Contributions to the U.S. Health Care System
    (University of Minnesota, College of Pharmacy, 2010) Schommer, Jon C.; Planas, Lourdes G.; Johnson, Kathleen A.; Doucette, William R.; Gaither, Caroline A.; Kreling, David H.; Mott, David A.
    Objective: The overall goal for this study was to conduct a segment analysis of the pharmacist workforce during 2009 based upon time spent in medication providing and in patient care services. Methods: Data for this study were obtained from the 2009 National Pharmacist Workforce Survey in which a random sample of 3,000 pharmacists was selected. Cluster analysis was used for identifying pharmacist segments and descriptive statistics were used for describing and comparing segments. Results: Of the 2,667 surveys that were presumed to be delivered to a pharmacist, 1,395 were returned yielding a 52.3% overall response rate. Of these, 1,200 responses were usable for cluster analysis. Findings from this study revealed five segments of pharmacists: (1) Medication Providers, (2) Medication Providers who also Provide Patient Care, (3) Other Activity Pharmacists, (4) Patient Care Providers Who also Provide Medication, and (5) Patient Care Providers. The results showed that, in 2009, 41% of U.S. pharmacists were devoted wholly to medication providing (Medication Providers). Forty-three percent of pharmacists contributed significantly to patient care service provision (Medication Providers who also Provide Patient Care, Patient Care Providers who also Provide Medication, and Patient Care Providers) and the remaining 16% (Other Activity Pharmacists) contributed most of their time to business / organization management, research, education, and other health-system improvement activities. Conclusions: Based on the findings, we propose that the pharmacy profession currently has, and will continue to build, capacity for contributing to the U.S. health care system in new roles for which they have been identified. However, as shifts in professional roles occur, a great deal of capacity is required related to new service provision. Resources are scarce, so an understanding of the most appropriate timing for making such changes can lead to cost-effective use of limited resources for improving patient care.
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    Medication Experiences of Hispanic People Living with HIV/AIDS
    (University of Minnesota, College of Pharmacy, 2010) Sánchez, Luz Dalia
    Objective: The objective of this study was to describe the medication experiences of Hispanic people living with HIV/AIDS. Specific aims were to describe their current medication experiences and to describe how they viewed their medication history in order to determine essential themes for improving culturally-appropriate medication therapy management services. Methods: A qualitative, phenomenological research methodology was employed. Ten adults living with HIV/AIDS were audiotaped during semi-structured, in-depth interviews conducted in Spanish. In addition to audiotaping, field notes were taken. Thematic analysis of text was done to obtain themes consistent with the research objectives. Analysis was accomplished in two phases. The first phase applied Van Manen’s lifeworld existentials of lived body, lived time, lived relation and lived space as the organizing framework for identifying themes. The second phase identified “essential themes” using holistic, selective, and detailed approaches that were applied to the themes identified in the first phase. Results: The results showed that lifeworld existentials were relevant medication experiences for Hispanic patients living with HIV/AIDS and their medication-taking behavior during their lives. Ten themes were identified. From these, we identified an overall “essential theme” comprised of: (1) Duality of Living with HIV/AIDS and (2) Primacy of Medications for Hispanic HIV/AIDS patients. Conclusions: The findings revealed that the medication taking experiences for Hispanic people living with HIV/AIDS can be described in terms of the duality of living with HIV/AIDS as “living dead” patients and in terms of the centrality that medications take in their lives, even to the point of a spiritual level.
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    Hospitalized Patients’ Perceived Knowledge and Risk of Monoamine Oxidase Inhibitor Medications Before and After a Pharmacist’s Classroom-Based Education
    (University of Minnesota, College of Pharmacy, 2010) Wenzel, Richard G.; Schommer, Jon C.
    Objective: Assess if a classroom-based pharmacy education service for hospitalized headache patients newly prescribed a monoamine oxidase inhibitor (MAOI) results in, 1) higher self-perceived medication knowledge, or 2) lower perceived risk of using MAOIs. Subjects: Individuals admitted to an inpatient headache unit over a five month period Methods: Patient survey administered before and after the education service to any patient newly prescribed an MAOI. Results: Seventy-eight individuals completed the study. Paired-samples t-tests showed that for each of the four items related to self-perceived medication knowledge, the scores reflected higher knowledge after the MAOI class compared to before the class (p < 0.05). For three out of the four items related to perceived risk of using MAOIs, the scores reflected a lower level of perceived risk after the MAOI class compared to before the class (p < 0.05). One item did not significantly change: “The MAOI prescribed for me is just as good as other products available for treating headache.” Conclusion: Our results demonstrate a pharmacist-conducted, classroom-based teaching method for newly prescribed MAOI patients can result in higher self-perceived medication knowledge and lower perceived risks.
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    Will Translational Science Help Reduce Costs of Illness?
    (University of Minnesota, College of Pharmacy, 2010) Kockaya, Guvenc; Wertheimer, Albert I.
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    A Lifestyle Medicine Clinic in a Community Pharmacy Setting
    (University of Minnesota, College of Pharmacy, 2010) Lenz, Thomas L.; Skradski, Jessica; Skrabal, Maryann Z.; Ferguson, Liz; Monaghan, Michael S.
    Chronic diseases continue to be a significant burden to the health care system. Pharmacists have been able to show that drug therapy for patients with chronic diseases can be improved through medication therapy management (MTM) services but have yet to become significantly involved in implementing lifestyle modification programs to further control and prevent chronic conditions. A novel and innovative lifestyle medicine program was started by pharmacists in a community pharmacy in 2008 to more comprehensively prevent and manage chronic conditions. The lifestyle medicine program consists of designing seven personalized programs for patients to address physical activity, nutrition, alcohol consumption, weight control, stress management, sleep success, and tobacco cessation (if needed). The lifestyle medicine program complements existing MTM services for patients with hypertension, dyslipidemia, and/or diabetes. This program is innovative because pharmacists have developed and implemented a method to combine lifestyle medicine with MTM services to not only manage chronic conditions, but prevent the progression of those conditions and others. Several innovative tools have also been developed to enhance the effectiveness of a lifestyle medicine program. This manuscript describes the program’s pharmacy setting, pharmacy personnel, participants and program details as well as the tools used to integrate a lifestyle medicine program with MTM services.
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    Innovations in pharmacy through pharmacy practice: A call for papers
    (University of Minnesota, College of Pharmacy, 2010) Uden, Donald
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    Inviting Scholarship in Leadership in Pharmacy
    (University of Minnesota, College of Pharmacy, 2010) Sorensen, Todd D.; Traynor, Andrew P.; Janke, Kristin K.