Volume 05, Number 2, 2014

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Assessing Pharmacists’ Attitudes and Barriers Involved with Immunizations
(University of Minnesota, College of Pharmacy, 2014) Aldrich, Sarah; Sullivan, Donald
Medication non-adherence in the homeless population in an Intermountain West city
(University of Minnesota, College of Pharmacy, 2014) Unni, Elizabeth J.; Ashment, Riki; Miller, Elizabeth; Draper, Andrew M.
Background: Homelessness happens when people or household are unable to acquire and/or maintain housing they can afford. Approximately 17% of homeless individuals are also chronically ill. Studies have often not objectively measured medication non- adherence among the homeless population, probably due to lack of consistent pharmacy records. This study proposed to objectively estimate medication non-adherence to chronic medications among the homeless population in Salt Lake City, Utah. Methods: A retrospective study design was used based on the pharmacy records from the Fourth Street Pharmacy based on four classes of chronic medications – asthma, diabetes, statins, and psychiatric medications. Data was collected between November 1, 2010 and February 28, 2011 on the variables: date of original prescription, number of refills on the original prescription, date of 1st, 2nd, 3rd, and 4th fills, age, gender, and race. Primary non-adherence and medication refill non-adherence based on Continuous Measure of Medication Gaps were calculated. Results: The medication refill non-adherence rate was 38.8% with asthma medications, 38.5% with diabetic medications, 27.2% with statins, and 47.1% with psychiatric medications. The primary non-adherence rate varied from zero percent to 20%. Conclusion: The study concluded that this population has comparable non-adherence rates with asthma, diabetes, cholesterol lowering, and certain psychiatric medications than the general population.
Addressing Clinical Faculty Need: Creating a Process and Evaluation for Peer Review of Practice
(University of Minnesota, College of Pharmacy, 2014) Moon, Jean Y.; Reidt, Shannon; Undeberg, Megan; Schullo-Feulner, Anne
Objectives: To describe the evolving process and evaluate the perceived value of peer review for clinical faculty. Methods: Using a 5-point Likert scale, clinical faculty rated the value of an electronic peer review process by completing an electronic 30 item survey across six areas of clinical faculty practice-related activity. Based on feedback, modifications were made and faculty were re-surveyed the following year. Results: Initially, 78% of faculty found peer review to be beneficial, mostly in the area of practice development and portions of practice dissemination. After modifications, 45% found peer review to be beneficial. Conclusions: Clinical faculty are challenged to leverage their practice into teaching and scholarly activities; however, clinical faculty often need feedback to accomplish this. Although the peer review process was designed to address perceived needs of clinical faculty, the process is dynamic and needs further refinement. Overall, clinical faculty find value in a peer review process. This evaluation of peer review illustrates the challenges to provide feedback across six key areas of clinical faculty activity.
Integrating Components of Medication Therapy Management Services into Community Pharmacy Workflow
(University of Minnesota, College of Pharmacy, 2014) Lester, Corey A.; Helmke, Jennifer L.; Kaefer, Tana N.; Moczygemba, Leticia R.; Goode, Jean-Venable R.
Objective: The objective of this study was to develop and evaluate a process for integrating components of medication therapy management services into a community pharmacy workflow. Secondary objectives were to evaluate outcomes as well as patient and pharmacist satisfaction with this change. Methods: This prospective, 3-month observational study took place in a small, independent community pharmacy. This intervention included a redesigned work system that included a seated private desk area and focus on the pharmacist, rather than the technician, being the first contact when patients entered the pharmacy. Pharmacists participated in a focus group before and after the implementation of the new workflow to better understand the delivery of the intervention and assess satisfaction. Process outcomes included time spent with the patient, the number of medication-related problems identified and recommendations made, the type of disease education provided, type and number of immunizations administered, and health monitoring tests performed. Patient satisfaction surveys were distributed after completing the intervention during the third month of the study. Results: A total of 56 patients were enrolled in this study resulting in 82 encounters. Forty medication-related problems, including experiencing an adverse drug reaction and ineffective therapy, were identified with recommendations made to patients or prescribers. Disease education, such as goals of therapy, was provided 46 times. Health monitoring tests, such as blood pressure, were performed 16 times and eight immunizations were administered. The revised workflow incorporating components of MTM services was successful in that 39% of encounters were less than two minutes and 49% of encounters were between two and five minutes in length. Only 12% of encounters were greater than five minutes. Overall, patients were very satisfied with the intervention. Pharmacists responded positively, but expressed concern that the changes to the work system prevented them from overseeing technician functions. Conclusion: Pharmacists in community practice are able to provide components of medication therapy management services during a brief, face-to-face interaction with patients. Overall, patients and pharmacists were satisfied with the changes to the pharmacy work system and that additional work system changes are needed to further expand the role of the community pharmacist and facilitate patient-pharmacist interactions.
Fluconazole-Associated Birth Defects: A Comprehensive Review
(University of Minnesota, College of Pharmacy, 2014) Firth, Janssen M.; Daniel, Nicholas; Hughes, Peter J.
Background: The August 2013 publication of a large historical cohort study in the New England Journal of Medicine has reignited interest in the potential teratogenic effects of fluconazole when used in pregnant females. Fluconazole is an effective and commonly-utilized antifungal medication. Thus, maternal and fetal exposure to fluconazole is expected in the general population, and pharmacists are expected to counsel patients regarding any risks to their prescribed treatment. Methods: A literature review of all published literature indexed to PubMed (January 1966 to October 2013) and International Pharmaceutical Abstracts (January 1975 to October 2013) including fluconazole and teratogenic effects and published in the English language was conducted. Results: Fourteen publications were included for analysis including case reports (n=7), cross-sectional research (n=2), and historical cohort studies (n=5). Conclusion: There appears to be little to no fetal risk resulting from a single dose or short duration antifungal therapy with fluconazole. However, prolonged high-dose fluconazole therapy has increased potential to confer teratogenic effects. In those cases, the risks of such therapy should be weighed against potential benefits.
Pharmacist Perspectives on Medication Costs and Affordability: A Pilot Study
(University of Minnesota, College of Pharmacy, 2014) Shinde, Shraddha; Shah, Bupendra
Background- Research on pharmacist provided care and services has rarely focused on medication cost and affordability. This study aims to bridge the gap by examining pharmacists’ perspectives of medication costs and affordability. Objective- To explore pharmacists’ perceptions about medication cost burden for patients, their communication with patients about i) ability to afford medications, ii) price, and iii) ways to reduce medication cost burden, their perceptions about ways to help improve affordability of medications and the barriers to communication. Method- A cross sectional exploratory study design was utilized. A convenience sample of pharmacists working in community pharmacies in Brooklyn was approached and asked to complete a survey. The survey questions examined the extent to which pharmacists: 1) perceived medication cost to be a burden, 2) initiated discussion about i) ability to afford medications, ii) price of medications, iii) ways to reduce cost burden. Pharmacists were also asked to opine on how to improve affordability of medications and their perceived barriers for such communication with the patients. Questions were formulated to differentiate pharmacists’ perceptions and behaviors in regards to dealing with patients with (PWI) and without insurance (PWOI). Data was analyzed using SPSS version 17.0. Result- A total of twenty-six pharmacists out of 54 approached participated in the study. Majority of the pharmacists reported the cost of medication to be extremely/very burdensome for PWOI (73%) than PWI (23%). In contrast, more pharmacists reported initiating a discussion very often/always about affordability with PWI (35%) than PWOI (20%). Discussions about price of medications were more common than discussions about affordability and ways to reduce medication burden. On an average, 33% of the pharmacists suggested generics as a way to improve affordability of the medications for PWI and PWOI. Conclusion- Patient–pharmacist communication on affordability and ways to reduce cost burden occurs very infrequently. Understanding the perspectives on patient –pharmacist communication on medication cost may help in developing effective strategies and may help reduce cost-related medication non-adherence.
Introducing Pharmacogenetics and Personalized Medicine via a Weblog
(University of Minnesota, College of Pharmacy, 2014) Bova, Kaitlin; Bova, Sara; Hill, Kevin; Dixon, Mark; Ivankovich, Diana; Kisor, David F.
to freshmen pharmacy students’ knowledge base. Methods: Incoming freshmen pharmacy students were invited by email to enroll in a one semester-hour, elective, on-line blog-based course entitled “Personal Genome Evaluation”. The course was offered during the students’ first semester in college. A topic list related to PGt and PM was developed by a group of faculty with topics being presented via the blog once or twice weekly through week 14 of the 15 week semester. A pre-course and post-course survey was sent to the students to compare their knowledge base relative to general information, drug response related to PGt, and PM. Results: Fifty-one freshmen pharmacy students enrolled in the course and completed the pre-course survey and 49 of the 51 students completed the post-course survey. There was an increase in the students’ general, PGt and PM knowledge base as evidenced by a statistically significant higher number of correct responses for 17 of 21 questions on the post-course survey as compared to the pre-course survey. Notably, following the course, students had an increased knowledge base relative to “genetic privacy”, drug dosing based on metabolizer phenotype, and the breadth of PM, among other specific points. Conclusions: The study indicated that introducing PGt and PM via a blog format was feasible, increasing the students’ knowledge of these emerging areas. The blog format is easily transferable and can be adopted by colleges/schools to introduce PGt and PM.
Team-based learning (TBL): An Argument for Faculty’s Evaluation
(University of Minnesota, College of Pharmacy, 2014) Kebodeaux, Clark D.; Vouri, Scott Martin; Hurd, Peter D.
Team-based learning (TBL) is increasingly used for presenting educational information to students in colleges of pharmacy. Several studies have shown a positive impact on students both in terms of academic performance and comprehension. Current literature does not provide the full perspective of faculty, who are incorporating this methodology into the classroom. Cross-sectional surveys and commentary within manuscripts describe mixed findings regarding the faculty’s perception of TBL. The aims of this paper are: 1) to describe why faculty evaluation of TBL is important, 2) to outline variables for consideration in faculty evaluations of TBL, and 3) to describe uses for the data from faculty evaluation of TBL.
Leadership: Three Key Employee-Centered Elements With Case Studies
(University of Minnesota, College of Pharmacy, 2014) Summerfield, Marc
Time and Motion Study of Influenza Diagnostic Testing in a Community Pharmacy
(University of Minnesota, College of Pharmacy, 2014) Klepser, Donald; Dering-Anderson, Allison; Morse, Jacqueline; Klepser, Michael; Klepser, Stephanie; Corn, Carolyn
Background: It has been shown that use of rapid diagnostic tests (RDTs) is able to reduce costs and improve the prescribing practice of antivirals (i.e. oseltamivir) among patients with influenza-like illnesses (ILIs). Using existing Clinical Laboratory Improvement Amendment (CLIA)-waived RDTs and collaborative practice agreements, similar to those used to allow pharmacists to administer vaccines, it is possible for patients to seek point-of-care treatment for influenza or flu-like symptoms at a local pharmacy. Following a review of the patient’s symptoms by a trained pharmacist, the qualified patient is offered an RDT to determine if the influenza virus is the cause of the symptoms. Based on the results of the RDT, the patient is provided with the appropriate treatment as defined by an approved practice agreement. Objective: The aim of this study was to evaluate the feasibility of incorporating an RDT for influenza into community pharmacy practice. Methods: This time and motion study was conducted at three community pharmacy locations, and a total of eight simulated patient visits were completed utilizing a standardized patient. In addition to determining a total time of the encounter, each simulation was divided into nine timed sub-categories. For data analysis, the time spent in each of the nine sub-categories was assigned to the pharmacist, pharmacy technician, or patient. Time and motion methodologies were used to estimate the total time required to provide the RDT service, to determine the amount of active time required of the pharmacist and pharmacy technician, and to evaluate the ability of the staff to provide the service within its existing workflow. Results: The average total time to complete the entire patient encounter for an influenza assessment utilizing an RDT was 35.5 minutes (± 3.1 minutes). On average, the pharmacist spent 9.4 minutes (± 3 minutes) per encounter or about 26.5% of the entire encounter. When the pharmacy technician collected the vital signs, the pharmacist-required time was reduced to 4.95 minutes (± 2.7 minutes), which was about a 48% reduction. Conclusions: The results indicate that an RDT program for influenza assessment required no more than a modest amount of pharmacist time and could be successfully incorporated into regular workflow with little to no disruption of other activities. As such, this approach to influenza management may be a feasible service for community pharmacies to offer patients. This was especially true if the pharmacy had well-trained technicians on staff that could support the service with collection of patient histories and vital signs.