APhA2014 ABSTRACTS Adherence and Persistence

Transcription

APhA2014 ABSTRACTS
APhA2014 abstracts of contributed papers
The following are abstracts of original research being
presented at APhA2014, March 28–31, 2014, Orlando, FL.
Inquiries specific to the research should be directed to the
contact author, indicated in the abstracts by underlined
name.
The 2014 abstracts are grouped into the following
themes to better facilitate review by specific topic or interest area: Adherence and Persistence; Reimbursement;
Cardiovascular Care; Collaborative Practice; Communication/Patient Education; Diabetes; Educating the Educators; Geriatrics and Long-Term Care; Health Disparities
and Cultural Issues; Health Literacy; Immunizations; Law
and Regulations; Marketing and Management; Maternal,
Child, and Women’s Health; Medication Reconciliation;
Mental Health; Medication Therapy Management; Nuclear
Pharmacy; OTC, Self-Care, and CAM; Pain Management;
Patient Attitudes and Behavior; Patient Care Services; Per-
Adherence and Persistence
1—ASSESSING THE IMPACT OF A
PHARMACIST-DELIVERED MEDICATION
SYNCHRONIZATION
PROGRAM ON CHRONIC MEDICATION ADHERENCE. Rabey J, Monte S,
McEvoy A, University at Buffalo School
of Pharmacy and Pharmaceutical Sciences, E-mail: [email protected]
Objective: The primary objective of
this study is to determine how a pharmacist-led medication synchronization
program impacts adherence to chronic
medications.
Methods: This retrospective study
will be conducted at an independent
community pharmacy. Patients will be
included if they have been enrolled in the
pharmacy’s medication synchronization
program for ≥9 months with ≥3 consecutive synchronized refills and are taking
≥1 of the following chronic medications:
oral hypoglycemic agents, antihypertensive agents with a renin–angiotensin
system antagonist mechanism, agents
with an HMG-CoA reductase inhibitor mechanism. Qualified patients will
be matched to controls, not enrolled
in the program, by age, sex, and active
prescription(s) for the same chronic
medication therapeutic class during the
same time period. All patient medication profiles will be reviewed for chronic
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sonalized Medicine/Pharmacogenomics; Pharmacist Behaviors and Attitudes, Pharmacoeconomics and Outcomes,
Professional Development; Public Health; Quality and
Safety; Respiratory Care; Substance Abuse and Addictions;
Specialty Pharmacy; Technology, Workforce and Manpower; and Emerging Topics.
APhA is especially proud to note this year’s presented
papers from current student pharmacists and pharmacy
residents. The experience of presenting at a national meeting will surely serve these emerging practitioners well as
they begin their careers in pharmacy.
In the abstracts, “NA” denotes that the information was
not available when the abstract was prepared or not applicable. Encore presentations—papers presented previously
at other meetings—are marked with a special symbol (Q).
doi: 10.1331/JAPhA.2014.14511
medication days’ supply and refill dates.
Medication adherence will be calculated
using proportion of days covered (PDC),
where a PDC >80% will be considered
adherent. Data will be analyzed to compare chronic medication adherence as
determined by PDC of the synchronization program group to the control group.
Results: Research in progress. An
estimated 100 patients will be eligible for
the study. This study will contribute to
the lacking evidence on pharmacist-led
medication synchronization programs
and the potential for pharmacists to have
an efficacious role in improving patients’
medication adherence to chronic pharmacotherapy. If successful, this study
may provide the framework and impetus for larger studies and in structuring
medication synchronization programs in
the community pharmacy setting.
2—CHANGE
IN
MEDICATION
NONADHERENCE AND BELIEFS
IN MEDICATIONS OVER TIME IN
OLDER ADULTS. Unni E, Roseman
University of Health Sciences, Farris K,
University of Michigan, E-mail: eunni@
roseman.edu
Objective: This study seeks to determine how medication nonadherence and
beliefs in medications change over time
in older adults because this change can
impact adherence interventions.
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Methods: A longitudinal study was
conducted using an Internet-based survey administered by Harris Interactive
for a sample Medicare population on
prescription drug utilization. The survey also collected data on medication
adherence (using the 4-item Morisky
scale) and beliefs in medications (using
Horne’s Beliefs in Medications Questionnaire). The data were collected in two
phases: a baseline survey in October 2005
and a follow-up survey in October 2007.
Descriptive analyses, correlation, and t
tests were used to determine the significant relationship between the variables
over time.
Results: A total of 436 respondents
answered both surveys. The mean age
was 72.54 (± 5.49) years for baseline survey and 74.53 (± 5.49) years for the follow-up survey. Fifty-five percent of the
respondents were female; 16% had high
school or equivalent education; 38% had
some college and 40% had at least 4 years
of college education; 56% had an annual
income <$50,000; 92% were white; and
58% were married.
For all respondents, from the baseline to follow-up survey, there was a
significant increase in both necessity beliefs (16.42 to 17.13) and concern beliefs
(11.62 to 11.69). There was a significant
correlation between baseline and followup beliefs (0.656 for necessity beliefs and
Journal of the American Pharmacists Association
APhA2014 ABSTRACTS
0.534 for concern beliefs). The correlation
between baseline and follow-up nonadherence (0.341) also was significant. In
both baseline and follow-up survey, nonadherent individuals had significantly
higher concern beliefs than adherent individuals. Additionally, concern beliefs
had a significant correlation with both
baseline and follow-up nonadherence
rather than necessity beliefs. Baseline
nonadherence was a significant predictor of follow-up nonadherence.
Conclusion: Changes in necessity
and concern beliefs in medications occur,
and concern beliefs seem to be more important than necessity beliefs.
to 365 days’ supply of opioid therapy
were 25%. Adherence for the medications (MPR ≥80%) under study were, beta-blockers 40%, ACE inhibitors 46.6%,
biguanides 41.3%, and sulfonylureas
45.5%. No statistical differences were
found in adherence rates based on opioid
therapy.
Conclusion: Medication adherence
remains problematic for many health
conditions. Opioid use among the elderly could lead to untoward side effects.
More research is needed to determine
the appropriate use of opioids in the elderly and whether there is any impact on
chronic medication adherence.
3—CHRONIC MEDICATION ADHERENCE AMONG OPIOID USERS IN A MEDICARE ADVANTAGE
PLAN. Fleming M, Upadhyay N, University of Houston, E-mail: mlflemi2@
uh.edu
Objective: Elderly patients are at
greater risk of adverse effects associated
with opioid therapy. Sedation and drug
interactions may impact medication adherence with chronic disease therapies
(e.g., antihypertensives). The study objectives were to describe the prevalence
of chronic opioid therapy in an elderly
population and examine the impact of
opioid therapy on chronic medication
adherence among patients with cardiovascular and diabetic disorders.
Methods: A retrospective claims database study of a continuously enrolled
(2009–2010) Texas Medicare Advantage
Plan’s beneficiaries (>60 years of age)
with an International Classification of
Diseases–9th revision diagnosis code for
cardiovascular and diabetic disorders
were included. Prescription claims for
beta-blockers, angiotensin-converting
enzyme (ACE) inhibitors, biguanides,
diuretics, and sulfonylureas were examined to determine adherence using
medication possession ratio (MPR) of
≥80%. Opioid use was categorized into
2 groups: <90 days and 90 to 365 days
of use. Logistic regression was used to
determine the impact of opioid therapy
on medication adherence for each drug
class.
Results: Opioid prevalence in the
study sample was 53.1%. Patients on 90
4—EFFECT OF AN ADHERENCE
PROGRAM ON A1C IN PATIENTS
WITH TYPE 2 DIABETES MELLITUS. Komaiko K, St. Louis College
of Pharmacy, Seiler K, Medical Arts
Pharmacy, Richard III L, Logan R, L&S
Pharmacy, Deacon C, Medical Arts Pharmacy, Bollinger S, Health Priorities Inc.,
Gattas N, St. Louis College of Pharmacy,
E-mail: [email protected]
Objective: This study seeks to determine the effect of a pharmacist-run adherence program (AP) on A1C.
Methods: This 28-week, singlecenter, parallel-design, intent-to-treat,
randomized control trial will implement
an AP at an independent community
pharmacy in a low-income, rural area
with a high prevalence of diabetes. The
pharmacy will identify patients based on
diabetes medication use and will involve
a minimum of 110 patients. Patients included in the study will be age ≥18 years
and have type 2 diabetes mellitus taking
diabetes medication, and patients will
be initially excluded if they have gestational diabetes, already enrolled in AP,
take metformin for polycystic ovary syndrome, and/or had a change in diabetes
medication in the 6 months prior to enrollment. Patients will be excluded from
data analysis if diabetes medication is
initiated, discontinued, or changed during the study data collection period or
if patients change weight significantly.
After patients’ consent, they will be randomized to either the control group (not
enrolled in the AP) or the test group (enrolled in the AP). The primary endpoint
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is change in A1C, with secondary endpoints of change in weight and proportion of days covered (PDC) of diabetes
medicines. A1C, weight, and PDC will
be collected on all subjects initially, at 3
months (A1C only) and 6 months. Statistical analysis comparing groups will
utilize a t test. Demographic information
of patients also will be collected and reported.
Results: Research is currently undergoing institutional review board approval. Previous studies have shown
that this adherence program affects PDC,
however it is unknown whether it affects
overall diabetes outcomes. If it is found
to be true, then use of a pharmacist-run
adherence program should be encouraged among community pharmacy practices.
5—EFFECT OF A PHARMACYBASED
INTERVENTION
ON
MEDICATION ADHERENCE AND
HEALTH CARE COSTS. Pringle J,
University of Pittsburgh School of Pharmacy, Boyer A, CECity.com Inc., Conklin M, Pharmacy Quality Solutions Inc.,
McCullough J, Rite Aid Corporation,
Aldridge A, RTI International, E-mail:
[email protected]
Objective: The objective of this
study was to evaluate the impact of a
pharmacy-based intervention on patients’ adherence to 5 chronic medication
classes and on health care costs.
Methods: The Pennsylvania Project
was a quasi-experimental prospective
study conducted at community pharmacies. The study assessed 59,496 patients
aged ≥18 years who received at least 2
medication fills during the period from
January 2010 to December 2011. Pharmacies were assigned to an intervention or
control group. Intervention group pharmacists received monthly performance
measures via a cloud-based platform.
Patients were universally screened for
poor medication adherence risk at intervention pharmacies. Pharmacists gave
patients who screened positive a brief intervention based on motivational interviewing principles. Improved medication adherence was measured by proportion days covered 80% or greater during
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APhA2014 ABSTRACTS
ing the intervention phase for patients
whose pharmacy behaviors were available for at least 270 days in each period.
Annual patient health care costs (2010
and 2011) were drawn from claims data
provided by Commercial, Medicare, and
Medicaid insurers.
Results: For all medication classes,
intervention significantly (P<0.01) improved adherence even after propensity
score adjustments and controlling for
differences in age, sex, insurance plan,
pre-intervention adherence, health
care costs, and diagnoses. This increase
ranged from 4.8% for oral diabetes
medications to 3.1% for beta-blockers.
Calcium channel blockers, statins, and
renin–angiotensin system antagonists
had increases of 3.3%, 4.1%, and 3.7%,
respectively. Additionally, there was a
significant reduction in overall health
care spending for patients taking statin
medications and oral diabetes medications ($20 per patient per month [PMPM]
and $28 PMPM, respectively).
Conclusion: The pharmacist-provided intervention significantly improved medication adherence across all
5 medication classes examined and reduced health care costs for 2 medication
classes. This study demonstrated that
pharmacist-provided intervention is a
cost-effective tool that may be applied in
community pharmacies and other health
care sites across the country.
outcomes of patients with diabetes mellitus and/or hypertension, measured by
a change in A1C and/or blood pressure,
respectively, from baseline.
Methods: Patient data will be collected through a retrospective chart review
of patient medical and pharmacy dispensing records. Patients will be included in the study if they started receiving
MAP between January 1, 2012 and June
30, 2012. Patients will be excluded if they
fill chronic medications at >1 pharmacy
or if they stopped receiving primary
care at this PCMH prior to July 1, 2013.
Patients will be separated into 2 cohorts:
those who received only MAP and those
who received both MTM and MAP. For
the purpose of this study, patients will
serve as their own controls and change
from baseline will be analyzed. At baseline, the medication regimen complexity
index will be assessed. To measure adherence, medication possession ratio will
be retrospectively analyzed at baseline
and on July 1, 2013. Clinical outcomes,
including A1C and blood pressure, also
will be analyzed at baseline and on July
1, 2013 (with or without MTM).
Results: Research in progress. Data
collection will begin post institutional
review board approval. The anticipated
outcome is that patients will have greatly
improved adherence to chronic medications that will result in improved health
outcomes.
6—THE EFFECTS OF BOTH MEDICATION ADHERENCE PACKAGING AND MEDICATION THERAPY
MANAGEMENT ON ADHERENCE
TO
CHRONIC
MEDICATIONS.
Clemans S, Holyoke Health Center, Dietle A, Massachusetts College of Pharmacy and Health Sciences University,
Cole T, Holyoke Health Center, E-mail:
[email protected]
Objective: The primary objective
will be to assess the change in adherence
to chronic medications in patients within
a patient-centered medical home (PCMH) who receive medication adherence
packaging (MAP) and in patients receiving both MAP and medication therapy
management (MTM). The secondary
objective will be to assess the effect of
MAP, with or without MTM, on health
7—EVALUATING PATIENT INTEREST IN AN ADHERENCE-FOCUSED
SMARTPHONE APP TO IMPROVE
HIV CARE. Cillessen L, Gaborcik J, Ellis J, The Ohio State University, Clark A,
AIDS Resource Center Ohio, Rodis J, The
Ohio State University, E-mail: ellis.349@
osu.edu
Objective: The objectives of this
study are to: (1) evaluate patient need
for adherence assistance; (2) evaluate
patient perceptions of a smartphone app
to assist in medication adherence; and
(3) evaluate the potential adoption of an
adherence app by a community pharmacy located within a clinic focused on
patients with human immunodeficiency
virus (HIV) infection.
Methods: AIDS Resource Center
(ARC) Ohio is a nonprofit organiza-
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tion that leads the fight against HIV/
acquired immunodeficiency syndrome
through awareness, advocacy, and care
in Ohio. ARC Ohio Pharmacy, located
within the ARC Ohio Medical Center,
serves the general public across Ohio.
With daily medication, HIV-positive
individuals can live long, healthy lives.
When HIV medication is not taken as
prescribed, HIV may become resistant
to medications, leading to HIV complications. Data on use of smartphone
apps for medication adherence is sparse
and unavailable in this population. This
study involves conducting a survey to
determine whether ARC Ohio Pharmacy
will adopt an adherence-focused smartphone app to enhance adherence and
thus patient health and longevity. Anonymous paper surveys will be distributed
to patients of ARC Ohio Medical Center
and Pharmacy in the reception area to
assess patients’ current adherence habits
and techniques as well as perceptions on
utilization of a smartphone adherence
app. Descriptive statistics will be used to
analyze results.
Results: Research in progress. Reported results will describe patients’
current use of adherence aids, need for
adherence assistance, and perceptions of
a smartphone app for adherence. Results
will provide investigators with information to determine whether adoption of a
smartphone app is reasonable in this local population.
8—EVALUATING PATIENTS’ PERCEPTIONS OF BLISTER PACKS DISPENSED IN A COMMUNITY SETTING AND ITS IMPACT ON THEIR
ADHERENCE. Pinto S, Bechtol R, Gaffney K, The University of Toledo College
of Pharmacy and Pharmaceutical Sciences, E-mail: [email protected]
Objective: The purpose of this study
is to evaluate patients’ perceptions of a
blister packaging system and the impact
of blister packs on their level of adherence after using the system.
Methods: This qualitative study
used a random sample of patients and
caregivers >18 years of age, taking ≥6
medications, with ≥3 chronic conditions,
and had used a blister packaging system
for ≥6 months dispensed at a community
APhA2014 ABSTRACTS
pharmacy. Three focus group sessions
were conducted over a 1-week period
using a previously developed discussion
guide. Participants were asked about
their experiences with the blister packs
and its impact on their level of medication adherence. Participants’ responses
were noted, and video- and audio-recorded. Transcripts were created and
analysis conducted using ATLAS v. 7.0.
Results: Thirty patients and caregivers participated. The overwhelming consensus was that blister packs had many
more advantages and were a preferred
option compared with other medication
organizing systems such as pill bottles/
vials, pillboxes, and medication pouches. All participants agreed that blister
packs overcame all challenges they had
experienced when using bottles/vials,
pillboxes, and/or medication pouches.
Nine themes arose depicting how blister
packs helped counter these challenges.
Among those reasons were that participants believed blister packs improved
their adherence and quality of life by
helping them remember to take their
medications; improved organization and
convenience of taking their medications;
reduced their stress and gave patients a
sense of security about their medications;
and improved their health. Prior to using the blister packs, only 7% (2/28) said
they were adherent to their medications.
Following the use of blister packs, 93%
(26/28) said they took their medications
as prescribed by their doctor and it resolved their nonadherence issues.
Conclusion: Adherence problems
often seen when using the most readily
available medication organizing systems
were countered by the use of the blister
packs.
9—EVALUATING
STRATEGIES
TO IMPROVE PERFORMANCE ON
CENTERS FOR MEDICARE AND
MEDICAID SERVICES STAR RATINGS IN CHAIN COMMUNITY
PHARMACIES. Barton K, University of
Arkansas for Medical Sciences, Schnur E,
Walmart Stores Inc., Flowers S, University of Arkansas for Medical Sciences, Hiland S, Walmart Stores Inc., E-mail: evan.
[email protected]
is to evaluate strategies for improving
performance on Centers for Medicare
and Medicaid Services (CMS) Star Ratings in a national chain community pharmacy.
Methods: A quality improvement
dashboard was recently implemented in
a chain community pharmacy that provided visibility to pharmacies’ performance on certain CMS Star Rating metrics. To achieve optimum performance
on these metrics, a program was developed to train pharmacy staff on how to
positively impact the ratings. For the
purposes of this study, approximately
48 pharmacies from 4 different regions
will pilot the training. Each group will
receive a different intensity of training.
Training components include a webinar, e-mail reminders with improvement strategies, and store-level access
to the quality dashboard that includes
additional improvement strategies. All
4 groups will receive the initial webinar explaining the strategies to monitor
performance on the 5 core measures: (1)
adherence to angiotensin-converting enzyme inhibitors (ACEI) and angiotensin
receptor blockers (ARB); (2) adherence
to oral diabetic medications; (3) adherence to statins; (4) use of an ACEI/ARB
in patients with diabetes; and (5) use of
high-risk medications in elderly patients.
The control group will receive only training from the webinar. The second group
will receive the webinar and monthly
e-mail reminders; the third group will
receive the webinar and have access to
the adherence dashboard; and the fourth
group will receive the webinar and have
access to both the e-mail reminders and
access to the adherence dashboard. Each
group will be blinded from one another
and notified separately that their pharmacies are a pilot for implementing the
dashboard.
Results: Research in progress. The
baseline performance of all 4 groups will
be recorded as the study begins, and then
monthly measure performance data will
be collected. Data will be evaluated using
descriptive analysis to show the trend for
each group in improving performance
on each of the 5 measures.
10—EVALUATION
OF
MEDICAj apha.org
TION ADHERENCE WHEN RECEIVING PRESCRIPTIONS FOR
HEPATITIS C FROM AN OUTPATIENT PHARMACY WITHIN AN
INTEGRATED HEALTH SYSTEM.
Lakdawala L, Nathanson A, Katzianer
J, Johns Hopkins Home Care Group, Email: [email protected]
of this study is to determine adherence
to telaprevir and/or peginterferon and
ribavirin, as the percent of patients with
proportion of days covered (PDC) >80%.
The secondary objectives are to: (1) compare adherence to chronic hepatitis C
medications, as determined by PDC, between patients who received a pharmacist face-to-face initial encounter versus
non–face-to-face initial encounter; and
(2) differentiate adherence to chronic
hepatitis C medication regimens for each
patient, as determined by PDC, at treatment durations of 12 weeks, 24 weeks, 48
weeks, or any point of early discontinuation.
Methods: This is a retrospective
review of chronic hepatitis C medications filled at the Johns Hopkins Outpatient Pharmacies from September 2011
through December 2013. Patients included are >18 years of age, have chronic hepatitis C, and have received prescriptions
from 1 of the 7 Johns Hopkins Outpatient
Pharmacies for at least the first 3 months
of therapy. Those excluded did not fill
their chronic hepatitis C medications for
the first 3 months, or received boceprevir triple therapy. Adherence will be
calculated using PDC for the following
medications: telaprevir and/or peginterferon and ribavirin. Reports will be generated from the pharmacy dispensing
systems and electronic medical records.
Descriptive statistics will be used to report the percent of patients with PDC
>80%. Descriptive statistics will be used
to compare adherence of patients based
on pharmacist initial encounter and at
defined points of treatment duration.
Results: Research in progress.
11—EVALUATION OF A PHARMACIST-DELIVERED
MEDICATION
SYNCHRONIZATION PROGRAM
IN AN INDEPENDENT COMMUNITY PHARMACY. Fillis R, McEvoy A,
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APhA2014 ABSTRACTS
derserved urban and rural areas. Data
collection is currently underway with
anticipated completion by the end of
December 2013. Results from this project can be utilized to educate these and
other pharmacists on possible ways to
improve patient care by counseling in a
way all patients can understand.
Q 101—IMPACT OF HEALTH LITERACY IN A DIABETES SELFMANAGEMENT EDUCATION PROGRAM. Smith S, Shealy K, Threatt T,
Presbyterian College School of Pharmacy, E-mail: [email protected]
was to: (1) determine whether baseline
health status correlates to a patient’s
health literacy level as indicated by A1C;
(2) determine health literacy level correlates to health outcomes as indicated by
A1C level at follow up; and (3) determine
health literacy level correlates with attendance in diabetes self-management education (DSME) program.
Methods: This cohort study assessed
patient health literacy status using the
Rapid Estimate of Adult Literacy in
Medicine–Short Form (REALM-SF) and
Newest Vital Sign (NVS) tools during
initial consults with patients referred to a
DSME program. Additional data collected included demographic information
and baseline A1C. Follow-up A1C was
compared with baseline. Attendance
was determined by number of missed
classes. Descriptive statistics were used
to analyze the data collected; change in
A1C was analyzed by paired Student t
test and correlation coefficients (r) were
calculated for attendance and A1C level
by health literacy level. This study was
approved by the institutional review
board. Informed consent was obtained.
Results: Thirty-nine patients were
enrolled in the study. More patients were
identified to have poor health literacy
with NVS than with REALM-SF. No significant correlation was found between
baseline health status and health literacy
level. Significant reduction in A1C was
seen in all patients; however, follow-up
health status per A1C negatively correlated with NVS scores. Patients with
poor health literacy missed an average of
2.4 appointments, compared with an av-
erage of 1.3 missed appointments by patients with higher health literacy. Scores
from REALM-SF negatively correlated
with attendance and were statistically
significant.
Conclusion: Overall the DSME program successfully improves patients’
health, and health literacy level seems
to affect attendance to DSME sessions.
the optimal tools for assessing health literacy level and subsequent interventions
to achieve health outcomes success in a
DSME program.
Original Citation: Smith S, Shealy
KM, Threatt T. Impact of health literacy
in a diabetes self management education
program administered through a school
of pharmacy. Presented at 19th Annual
Diabetes Fall Symposium for Primary
Health Care Professionals, Charleston,
SC
102—THE INFLUENCE OF FUNCTIONAL HEALTH LITERACY ON
QUALITY PATIENT-PHARMACIST
COMMUNICATION. King S, Union
University, Rogers E, Methodist Healthcare, Null K, University of Mississippi,
was to examine the relationship between
functional health literacy (FHL) and
quality patient-pharmacist communication among patients receiving anticoagulation therapy. Additionally, this study
assessed whether the time patients spent
within optimal therapeutic range differed by level of FHL.
Methods: In this study, 232 patients from 2 rural, pharmacist-staffed
anticoagulation clinics were asked to
participate in detailed telephone interviews concerning their interactions with
clinic pharmacists. A validated, 1-item
screening question was used to classify
patients as possessing either adequate
or inadequate FHL. Patients’ perceptions regarding general communication
with pharmacists were elicited using 6
domains from the Interpersonal Process
of Care (IPC) questionnaire. Indication,
target range, time in range of anticoagulation, and race/ethnicity were retrieved
from the database of the respective clinic.
Independent t tests were used to assess
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for differences between FHL groups on
each of the 6 IPC domains. Logistic regression was used to measure the association between inadequate FHL and the
IPC domains.
Results: Telephone interviews were
completed by 220 patients. Patients possessing inadequate FHL reported significantly worse ratings to the quality
of pharmacist communication than did
those possessing adequate FHL on 4 of
the 6 IPC domains (P≤0.05). The odds of
reporting poorer quality interpersonal
processes of care across these 4 domains
were significantly greater for those possessing inadequate FHL (P≤0.05). Patients with inadequate FHL did not differ
significantly from those with adequate
FHL in terms of time within therapeutic international normalized ratio (INR)
range or percent of INRs in therapeutic
range over the previous 12 months.
Conclusion: Patients receiving anticoagulation therapy also possessing
inadequate FHL appear more likely to
experience poorer communication with
pharmacists than patients possessing
adequate FHL. Pharmacists may be failing to adequately determine the extent
to which educational efforts for these
patients leads to intended consequences.
Educational efforts may be needed to
improve pharmacists’ communication
skills in these areas.
103—READERSHIP AND PERCEPTION OF MEDICATION GUIDES
AND PATIENT PACKAGE INSERTS
AT A STUDENT HEALTH PHARMACY. Buchman C, Boyce B, Muravez S, Oregon State University, E-mail: christina.
[email protected]
Objective: The printed Medication
Guide (MedGuide) and Patient Package Insert (PPI) that are required with
prescription drugs outline the risks of
taking the medication in language that
is patient-friendly and relatively easy to
read. The aim of this study is to evaluate
how often patients of a student health
pharmacy read the MedGuides/PPIs
of prescription medications and how
useful they have found the information
provided. The unique patient population
of a university setting eliminates some
potential confounders because it can be
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[email protected]
Objective: This study assessed the
patent life of new molecular entities
(NMEs) and new biologics (NBs) that
had a patent extension in the period
1985–2012.
Methods: Data were collected from
the U.S. Food and Drug Administration (FDA), the U.S. Patent and Trademark Office (USPTO), and the U.S. Federal Register websites for all new drugs
approved by the FDA in the period
1985–2012. Descriptive analysis was performed for all variables.
Results: The USPTO listed 499
NMEs/NBs with patent extensions,
representing 51.9% of NMEs/NBs approved in the study period. Complete
drug regulatory and patent information was available for 283 pharmaceuticals. The average patent extension was
2.72 ± 1.39 years. The patent extension
was longest for drugs in the Anatomical Therapeutic Chemical (ATC) classes
alimentary tract and metabolism (3.36
± 1.39 years), systemic hormonal preparations, excluding sex hormones and
insulins (3.03 ± 1.48 years), and nervous
system (3.03 ± 1.53 years). The shortest
patent extensions were granted to antiinfectives for systemic use (2.47 ± 1.22
years), sensory organs (2.47 ± 1.09 years),
and musculoskeletal system (2.34 ± 1.32
years). The average duration of the clinical trial period was 5.52 ± 3.41 years. The
longest clinical trial periods corresponded to musculoskeletal system (8.45 ± 5.38
years) and the shortest was for sensory
organs (4.31 ± 1.77 years). The average
FDA review time was 1.65 ± 1.31 years; it
was highest for respiratory system (3.22
± 2.34 years) and lowest for systemic hormonal preparations (0.98 ± 0.56 years).
The overall effective patent life without
patent extensions was 8.70 ± 7.01 years,
whereas the effective patent life with patent extensions increased to 11.71 ± 6.78
years. The longest effective patent life
corresponded to dermatologicals (13.59
± 1.03 years); and the shortest patent life
corresponded to cardiovascular agents
(6.56 ± 23.21 years).
Conclusion: There were significant
differences in the clinical trial periods,
FDA review time, and effective patent
life among the different ATC classes of
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new NMEs/NBs approved by the FDA
in the study period.
127—ASSESSING DIFFERENCES IN
THE CHARACTERISTICS OF THE
NEW PHARMACEUTICALS APPROVED BY THE FOOD AND DRUG
ADMINISTRATION AND THE EUROPEAN MEDICINES AGENCY.
Badawoud E, Alshehri N, Alqahtani S,
Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences
University, Rodriguez-Monguio R, University of Massachusetts, E-mail: [email protected]
Objective: This study aims to explore some areas of discrepancies between the Food and Drug Administration (FDA) and the European Medicines
Agency (EMA) in approving new molecular entities (NME) and new therapeutic
biologics (BLA) in the period from 1999
to 2011.
Methods: FDA and EMA websites
were utilized to retrieve data regarding
drug applications, approvals, orphan
status, and indications for new NMEs
and BLAs. The 2 systems were compared
using descriptive statistics and a t test
was applied to assess differences in averages. Significant level was set at 0.05.
Results: Both regulatory agencies
approved a total of 101 drugs (82 NME
and 19 BLA; all were FDA priority reviews). BLAs were submitted 1.25 ± 4.18
months later (median 0.33 months) and
approved 7.14 ± 5.47 months later (median 5.75 months) by EMA compared with
FDA. NMEs were submitted to EMA
1.44 ± 24.52 months later (median 0.44
months) and approved by FDA 6.67 ±
23.43 months later (median 7.49 months)
than EMA. The BLA average review
time was statistically significantly lower
(P<0.001) for FDA 7.67 ± 2.24 months
(median 6.21 months) than EMA 14.6 ±
3.33 (median 14 months). The NME average review time was statistically significantly lower (P<0.001) for FDA 9.25
± 9.10 months (median 5.98 months)
than for EMA 14.48 ± 4.09 (median 13.72
months). The number of products with
orphan designation was lower in EMA
(n = 33) than in FDA (n = 57). EMA granted orphan designation to 2 products that
did not have orphan designation in the
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United States. The United States granted
orphan designation to 13 products that
European Union. Differences in the indications approved in both systems were
observed in 24.8% (n = 25) of the drugs.
Conclusion: Significant differences
exist in the time elapsed between the filing and the approval of drugs as well as
in orphan designation. Harmonization
of the regulatory systems could facilitate
timely approval of essential pharmaceuticals.
128—COMMUNITY
PHARMACISTS’ ATTITUDES TOWARD AN
EXPANDED CLASS OF NONPRESCRIPTION DRUGS. Shah R, Holmes
E, West-Strum D, University of Mississippi School of Pharmacy, Patel A, Medical Marketing Economics, E-mail: [email protected]
Objective: There has been considerable discussion about creating a third
class of drugs which would not require
a prescription, but would require a pharmacist’s consultation upon purchase.
Recently the Food and Drug Administration (FDA) held a hearing that repositioned a third class as an expanded
nonprescription drug class termed as
the “new paradigm” using innovative
technologies. The objectives of this study
were to: (1) measure community pharmacists’ attitudes toward the new paradigm; and (2) determine whether these
attitudes differed according to practice
and demographic characteristics.
Methods: This cross-sectional study
was conducted using a self-report, webbased survey administered to a national
panel of community pharmacists. The
survey items were developed based
on existing scales in the literature and
the FDA’s proposed guidelines for the
new paradigm. A principal components
analysis (PCA) with VARIMAX rotation
and reliability analyses were conducted
to identify the factors affecting community pharmacists’ attitudes toward the
new paradigm. Descriptive statistics
were used to describe pharmacists’ attitudes. Multivariate Analysis of Variance (MANOVA) was used to determine
whether attitudes toward the new paradigm differed based on practice and de-
APhA2014 ABSTRACTS
(DM), and/or dyslipidemia medications.
Methods: This is a retrospective cohort study in HIV-positive patients ≥18
years of age who filled their antiretroviral, HTN, DM, and/or dyslipidemia
medications at a North Carolina community pharmacy after January 1, 2013.
Patients who receive personalized care
from a pharmacist for management of
their antiretroviral medications and
who have HTN, DM, and/or dyslipidemia will be evaluated. Refill dates over
a 6-month period will be collected for
antiretroviral, HTN, diabetes, and/or
dyslipidemia medications. Medication
adherence will be calculated for each disease state in which the patient received
the same medication regimen for at least
6 consecutive months. The proportion of
days covered method will be utilized to
calculate adherence. The mean antiretroviral adherence rate will be compared
with the mean medication adherence
rate for HTN, DM, and dyslipidemia using a Student t test.
17—NONADHERENCE IN RHEUMATOID ARTHRITIS PATIENTS:
INFLUENCE OF PATIENT-CENTERED FACTORS ON DISEASEMODIFYING
ANTIRHEUMATIC
DRUGS AND LABORATORY COMPLIANCE. Akpoji U, University of Pittsburgh, Cerussi N, Aggarwal R, University of Pittsburgh Medical Center Presbyterian, Coley K, University of Pittsburgh,
study are to: (1) assess the extent of oral
disease-modifying antirheumatic drug
(DMARD) nonadherence in patients
with rheumatoid arthritis (RA); (2) assess
factors contributing to nonadherence;
and (3) assess the degree of nonadherence to crucial laboratory toxicity monitoring.
Methods: This study is being conducted in an outpatient, hospital-based
autoimmune clinic, where a student
pharmacist works with rheumatologists
and staff to interview patients after their
visits. Patients included in this study are
adults diagnosed with RA who are prescribed DMARDs. Patients are screened
e82 JAPhA | 5 4 :2 | M AR/AP R 2014
to determine their level of adherence by
utilizing the Morisky adherence scale. A
Likert-scale questionnaire is then used to
assess the relative contributions of unintentional and intentional factors driving patients’ medication nonadherence.
Patient-centered factors can be divided
into 2 categories: unintentional factors
that limit patients’ capacity to take their
medication and intentional factors that
lead to a decision toward nonadherence.
Laboratory monitoring adherence is
measured by assessing whether the time
elapsed was >3 months or <3 months
since patients’ last blood tests.
Results: Research in progress. To
date, there have been 7 low-, 10 medium-, and 6 high-adherers observed.
Preliminary results demonstrate that
forgetfulness of doses affected more patients’ adherence in the low adherence
category (4/7) than that of the other 2
categories. Furthermore, 3 of 4 patients
who did not obtain their labs as prescribed had forgotten to make appointments. Overall, more patients identified
with the unintentional factors of nonadherence (11/20) than the intentional
factors (9/20), with forgotten doses and
side effects sharing equal proportions.
The surveys utilized in this project may
identify traits of high adherers that are
lacking in the other nonadherent groups.
Furthermore, this process may improve
the efficiency of medication therapy
management interventions by tailoring
them to patients’ predominant factors
of nonadherence, a feature commonly
lacking in published interventions for
patients taking DMARD therapy.
18—PATIENTS’ PERCEPTIONS OF
MEDICATION ORGANIZING SYSTEMS AND THEIR LEVEL OF ADHERENCE USING THESE SYSTEMS.
Pinto S, Bechtol R, Gaffney K, The University of Toledo College of Pharmacy
and Pharmaceutical Sciences, E-mail:
[email protected]
is to identify patients’ perceptions of
medication organizing systems and their
level of adherence using these systems.
Methods: This research project used
a qualitative study design. Participants
included patients and caregivers >18
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years of age, taking at ≥6 medications,
and having ≥3 chronic conditions. Three
focus group sessions were conducted
over a 1-week period using a previously developed discussion guide. Participants were asked about their positive
and negative experiences with using pill
bottles, pillboxes, medication pouches,
and blister packs. Additionally, researchers asked how these systems impacted
participants’ level of adherence to medications. Participants’ responses were
noted, and video- and audio-recorded.
Transcripts were created verbatim and
themes and findings were summarized
using ATLAS.ti 7.0.
Results: Thirty patients and caregivers participated. All participants reported using vials and pillboxes. Four participants had used medication pouches.
Participants believed vials were difficult
to open, contributed to forgetting to take
their medications, and did not provide
privacy in public settings. Pillboxes
helped minimize the need to open several pill bottles at a time and helped consolidate medications. Eighty-six percent
(24/28) said they missed ≥1 pill per week
using the 3 organizing systems. Fiftyfour percent (15/28) reported missing
≥10 pills per week with numbers as high
as 40 pills per week. Participants emphasized the need for an adherence solution
with characteristics, which included but
are not limited to: a system that serves as
a memory aid; provides a level of comfort and security with organizing their
medications; reduces stress and time
spent in organizing their medications
providing a sense of independence and
freedom; easy to use and travel friendly;
and aids in improving their health and
quality of life.
Conclusion: Current medication
organizing systems pose challenges to
medication adherence. There is a need
for a better solution that counters these
problems and aids in adherence.
19—PHARMACIST-LED FACILITATION OF ENROLLMENT IN A PATIENT ASSISTANCE PROGRAM
TO IMPROVE ADHERENCE AND
REDUCE COSTS IN A COMMUNITY
PHARMACY WITHIN A MEDICARE
ADVANTAGE PATIENT-CENTERED
APhA2014 ABSTRACTS
MEDICAL HOME. Poole T, Belmont
University College of Pharmacy, Arije S,
Rite Aid Pharmacy, Hagan A, Belmont
University College of Pharmacy, Milliken A, Smith A, James C, Cigna-HealthSpring, E-mail: [email protected]
Objective: Cost is commonly cited
as a barrier to medication adherence
and many geriatric patients are at an
increased risk of nonadherence due to
complex medication regimens and lowincome status. It has been reported that
more than 10% of Medicare beneficiaries
have engaged in cost-related nonadherence activities to reduce out-of-pocket
costs. Enrollment in a patient assistance
program (PAP) is a way to mitigate costrelated adherence issues; however, patients often find them cumbersome and
difficult to navigate. Through a concerted effort to facilitate successful enrollment of patients who qualify for patient
assistance, it is anticipated that cost savings to the health plan and patients will
be demonstrated and adherence will be
improved through overcoming patient
cost barriers.
Methods: Patients in need of assistance are identified through interaction
in the pharmacy or referral by a primary
care physician (PCP) in the on-site primary care clinic. Patients are screened
with general qualification requirements
to determine potential qualification. If
patients appear to qualify based on initial assessment, they are asked to return
with the necessary supporting documentation required for a 15-minute visit with
pharmacy personnel. At the visit, all
parameters of the application are completed and corresponding prescriptions
are gathered through collaboration with
the patient’s PCP. Complete applications are faxed to the respective manufacturer. Any errors or appeals that occur are managed by the pharmacy and
results are communicated to the patient.
Documentation of intervention occurs in
a standardized format within the clinic
electronic medical record.
Results: Research in progress. A
total of 202 patients were seen in the
service from January 2011 to December
2012. Preliminary data analysis indicates
an estimated cost savings of $318,033 to
the health plan and $60,843 to patients.
Further analysis of impact on cost savings and adherence is in progress.
20—PHARMACISTS’ INTERVENTIONS TO IMPROVE NONADHERENCE TO STATIN THERAPY: THE
SIGNIFICANCE OF PATIENT EDUCATION IN THE COMMUNITY
SETTING. Bonner B, Bailey-Wheeler J,
Sarpong D, Hart T, Harris M, Xavier University of Louisiana, E-mail: bbonner1@
xula.edu
study is to assess the effectiveness of
pharmacist-driven patient education
on improving medication adherence to
statin therapy.
Methods: The study will enroll 100
nonadherent patients receiving a statin
prescription from the pharmacy, who
are >18 years old and on a statin for ≥6
months. Patients on automatic refill will
be excluded from this study. Nonadherence, defined as failing to refill a statin
prescription consecutively within a 90day period, will be identified based on
prescription fill rates. Study participants
will have consented prior to enrollment.
Data collection will be by surveys including: demographics, medication adherence (Morisky 8-Item Medication Adherence Questionnaire), and health literacy
(Rapid Estimate of Adult Literacy in
Medicine, Revised). The intervention,
pharmacist-driven patient education,
will instruct patients on dyslipidemia
and the cardiovascular benefits of statin
therapy. Tailored intervention will be administrated to 3 stratified groups (classes
A–C) based on individual Morisky
scores (classes A, B, and C are low-, medium-, and high-adherence groups, respectively). The primary outcome will
be measured based on statin fill rates for
the next 60 to 90 days post intervention.
The effectiveness of the intervention will
be assessed by the hypothesized increase
of the statin prescription fill rates. The
following statistical methods will be employed to assess the effectiveness of the
intervention in improving medication
adherence: paired t test and McNemar
test as univariate analysis; and analysis
of covariance as a test that accounts for
potential confounders such as demographic factors and health literacy level.
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All significance tests will be at the alpha
level of 0.05. By providing the benefit of
patient medication and disease state education, this study will promote medication adherence, which has been proven
to improve morbidity and mortality.
21—PREDICTING FACTORS LEADING TO PRIMARY MEDICATION
NONADHERENCE AND ITS EFFECT ON HEALTH SERVICE UTILIZATION AMONG MEDICARE BENEFICIARIES WITH CARDIOVASCULAR DISEASE. Gangan N, Vaidya V,
Pinto S, The University of Toledo College
of Pharmacy and Pharmaceutical Sciences, Amialchuk A, The University of
Toledo, E-mail: Varun.Vaidya@utoledo.
edu
study are to: (1) identify primary medication nonadherence (PMN); (2) determine its effect on health service utilization; and (3) assess sociodemographic
factors associated with it among Medicare beneficiaries with newly diagnosed
cardiovascular disease (CVD).
Methods: This was a retrospective,
cross-sectional cohort study. Medicare
beneficiaries with newly diagnosed CVD
were identified using Medicare Current
Beneficiary Survey data from 2002 to
2006. Andersen’s model of health service utilization was used as a theoretical
framework to explain factors that may
predict PMN. A multiple nonlinear regression model was built to identify factors associated with PMN. To determine
the effect of PMN on health service utilization, adherent and nonadherent patients were matched by characteristics
using propensity scores.
Results: There were 7,542 Medicare beneficiaries newly diagnosed with
CVD from years 2002 to 2006; 334 of
those beneficiaries did not fill prescriptions representing 4.43% of the cohort
under study. Female patients (odds ratio
[OR] 0.682, 95% confidence interval [CI]
0.522–0.890), lower patient satisfaction
with health service (OR 1.074, 95% CI
1.040–1.109), and higher cardiovascular
burden (OR 1.248, 95% CI 1.122–1.388)
were significantly associated with PMN.
Nonadherent patients had fewer physiMAR /APR 2014 | 54:2 |
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APhA2014 ABSTRACTS
cian visits (P<0.0001) and outpatient visits (P = 0.03) than adherent patients.
Conclusion: Many patients failed
to fill their prescriptions showing PMN
among the study population. PMN
was particularly significant in female
patients, patients having low satisfaction with health service received, and
patients with higher number of cardiovascular conditions. With the recent
health care reform targeted at improving
overall quality of care, findings from this
present study provide guidance toward
identifying populations vulnerable to
PMN. PMN is a severe issue especially in
cases of chronic conditions such as CVD
than secondary adherence. A comprehensive approach involving physicianpharmacist collaborations could lead to
provision of appropriate interventions to
eliminate PMN. Future research should
focus on identifying more factors leading
to causality of PMN and devise strategies to reduce prevalence of PMN.
22—PRESCRIBING TRENDS IN
NONADHERENT HYPERTENSIVE
PATIENTS. Ta T, PGPA Pharmacy and
Ferris State University, Heetderks L,
PGPA Pharmacy, Meny L, Ferris State
University, E-mail: [email protected]
study are to: (1) document the effects of
antihypertensive medication nonadherence on blood pressure; (2) describe antihypertensive medication changes due to
medication nonadherence; and (3) report
the frequency of nonadherence documentation in patient charts.
Methods: Prior to initiation, this
study will be submitted to the institutional review board for approval. This
study is a retrospective chart review
of nonadherent hypertensive patients
from Federally Qualified Health Centers
(FQHC) serviced by Pharmacy Group
Practice Associates (PGPA) Pharmacy.
Eligible patients will include those ≥18
years of age who have a documented diagnosis of hypertension, a documented
initial and follow-up appointment with a
primary care provider, a recorded blood
pressure measurement, and are considered to be nonadherent to their antihypertensive medication regimen. Nonadherence will be defined as a prescrip-
e84 JAPhA | 5 4 :2 | M AR/AP R 2014
tion sent from a primary care provider
practicing in a FQHC that resulted in the
medication not being picked up within 4
weeks by the patient or patient representative and being returned to PGPA Pharmacy. Exclusion criteria include: patients
with congestive heart failure, chronic
kidney disease, atrial fibrillation, pulmonary hypertension, a history of myocardial infarction or stroke within the past 6
months, no hypertension diagnosis; patients receiving dialysis; patients utilizing other primary care facilities or pharmacies; and patients utilizing only nonpharmacological treatment for hypertension. Information to be collected from the
chart review will include blood pressure
at the initial and follow-up appointment,
the class of antihypertensive medication
prescribed at the initial appointment,
how medication therapy was modified
because of nonadherence, and if nonadherence was documented in the patient’s
chart. Appropriate statistics and tests
will be utilized and a P value of 0.05 will
determine statistical significance.
23—A QUALITATIVE ANALYSIS
ASSESSING PATIENTS’ PERCEPTIONS OF SERVICES OFFERED
IN AN ADHERENCE PHARMACY
PROGRAM. Pinto S, Bechtol R, Omerza
K, The University of Toledo College of
Pharmacy and Pharmaceutical Sciences,
study are to: (1) describe an adherence
pharmacy model; and (2) assess patients’
perceptions of the services offered.
Methods: Three focus group sessions were conducted over a 1-week
period using a previously developed
structured guide. Participants were patients and caregivers receiving products
and services at a community adherence
pharmacy for ≥6 months. Experiences
with pharmacy services, pharmacists,
and staff were evaluated. Responses
were noted, and video- and audio-recorded. Dialogue was transcribed and
analysis was conducted using ATLAS
7.0. Themes and findings were identified
and summarized.
Results: A new community pharmacy with a goal to impact medication
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adherence was established in August
2011. Patients learned about the pharmacy via flyers, billboard signs, televised ads, and/or physician referrals.
At enrollment, a medication list was created, medications synchronized, patients
counseled, and medications dispensed
in blister packs. Counseling sessions
with patients and caregivers included
education on their conditions, medications, and side effects. Follow-up phone
calls were made monthly or quarterly
corresponding with their refill dates.
These calls monitored changes to medications, addressed patient questions,
and assessed the need to schedule a follow-up face-to-face session. Blister packs
were picked up or delivered to patient
homes. Regarding patient perceptions,
participants felt pharmacists and staff
helped resolve pharmaceutical concerns
and genuinely cared about them. Service benefits included receiving health
care needs in a stress-free environment,
keeping track of patient refills, and receiving medications timely. Adherence
was impacted through patients better
understanding their medications, having pharmacists identify drug problems
and interactions, and assisting patients
with their therapy by making recommendations.
Conclusion: With emphasis placed
on medication adherence as a performance indicator, new practice models
impacting medication adherence are
needed. This newly developed adherence pharmacy seems to provide a platform for this service. Services provided
at the adherence pharmacy were positively received and were successful in
positively effecting medication adherence and changing medication-taking
behavior.
24—WITHDRAWN.
25—VARIABILITY OF ADHERENCE
OUTCOME MEASURES IN STUDIES EVALUATING ORAL ANTINEOPLASTIC TREATMENTS. Banda S,
Toscani M, Rutgers University, E-mail:
[email protected]
Objective: The current trend in
oncology shows a shift in patient selfmanagement efforts, namely medication
APhA2014 ABSTRACTS
adherence, due to an increasing number of antineoplastic treatments being
made available as oral therapies. Patient
adherence to these therapies is a major
concern, however there is currently no
universally accepted definition or optimal method to measure and evaluate adherence. The objective of this study was
to conduct a systematic literature review
assessing the variability of adherence
definitions and measurement methods
used in antineoplastic treatment studies.
Methods: A structured literature
search and review was performed using
MEDLINE to identify research articles
on controlled and uncontrolled studies
involving oral antineoplastic agent treatments from 2010 to 2013. Articles were
included if patient adherence and/or
non-adherence to an oral antineoplastic therapy was a primary or secondary
objective of the study. MeSH terms and
keywords including “adherence,” “compliance,” “persistence,” etc. were used as
part of the search strategy. Articles that
did not measure patient adherence in an
oral antineoplastic agent were excluded.
An assessment will be done on the adherence definition criteria and the adherence measurement methods defined in
each study. The variability in these adherence outcomes measures within the
respective cancer types will be a focus
for evaluation, organization, and future
reporting best practices.
Reimbursement
26—DO CHARACTERISTICS OF
THE MEDICAID POPULATION EXPLAIN DIFFERENCES IN MEDICAID FEE-FOR-SERVICE GENERIC
OUTPATIENT DRUG UTILIZATION
AND REIMBURSEMENT?. Alshehri
A, Balkhi B, Seoane-Vazquez E, Massachusetts College of Pharmacy and
Health Sciences University, Szeinbach S,
The Ohio State University, E-mail: [email protected]
Objective: This study aimed to determine whether Medicaid demographics would account for differences in
generic utilization, expenditures, and reimbursement among different Medicaid
programs in 2011.
Methods: Medicaid fee-for-service
outpatient pharmacy utilization and
expenditures, and reimbursement rates
for the year 2011 were extracted from
state-level data provided from the Centers for Medicare and Medicaid Services.
Descriptive analyses were performed for
all variables and linear regression analysis was performed to test the hypothesized association between Medicaid
demographic variables and differences
in generic utilization and reimbursement
rates.
Results: Fee-for-service Medicaid
expenditures (n = 46 states) reached
$27.8 billion and 173.4 million claims in
2011. Generic expenditures represented 17.3% of total expenditures (range
10.3%–29.2%) and generic utilization
72.2% of the claims (range 66.1%–84.8%).
Generic utilization rates were highest in
the Midwest (75.6% of total claims, n =
11) and lower in the Northeast (69.4%,
n = 9). The states belonging to the West
(72.2%, n = 10), South (72.0%, n = 14), and
Pacific (70.3%, n = 2) regions had similar
generic utilization rates. The average reimbursement was lowest in the Midwest
($14.27, n = 11), followed by the Northeast ($16.83, n = 9), South ($18.77, n = 14),
West ($21.10, n = 10), and Pacific ($28.93,
n = 2) regions. There were no statistically
significant associations between statelevel generic utilization rates and total
number of claims, total expenditures,
percentage of Medicaid eligible in each
age group, percentage of aged/disabled
eligible population, or sex of the eligible
population.
Conclusion: Substantial differences
were found in generic utilization rates
and reimbursement among the different Medicaid programs. The states of the
Midwest region had the highest generic
utilization rate and the lowest average
generic reimbursement amount. However, differences in utilization rates and
reimbursement amount were not related
to differences in Medicaid demographics
or in generic dispensing fees and reimbursement amounts among the different
states. Encouraging generic utilization
could result in substantial saving for the
Medicaid program.
27—PHARMACIST
BILLING
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IN
MEDICARE PART A AND PART
B CLAIMS. Schroeder M, Zhang Y,
Brooks J, University of Iowa, E-mail:
[email protected]
Objective: Although pharmacists
have advocated for Medicare provider
status in order to expand pharmaceutical
care services, little is known about reimbursement practices outside of Part D.
The objective of this study was to identify individuals who have successfully
gained reimbursement and characterize
the service mix and payment amounts
for products and services unrelated to
dispensing.
Methods: Medicare data for 2010
were obtained from the Chronic Condition Warehouse. This analysis included
Part A institutional claims (inpatient,
outpatient, skilled nursing facility, home
health agency, and hospice), and Part B
noninstitutional providers and claims
(carrier and durable medical equipment
[DME]). Pharmacists and pharmacies
were identified through National Provider Identification (NPI) numbers.
Healthcare Common Procedure Coding
System (HCPCS) codes were used to determine services and products provided.
Average claim amounts also were calculated.
Results: Although 186,805 pharmacists and pharmacies obtained an
NPI, only 7,725 were identified in 2010
Medicare Part A and Part B claims. The
majority (68%) was found in the DME
file and almost three-quarters were selfidentified individuals. A total of 189,313
claims were filed to Medicare and 93%
were for DME. Reimbursement amounts
varied widely. Carrier claims (i.e., for
non-institutional providers) on average were reimbursed $31.87, compared
with $96.32 for DME and $132.04 for outpatient. “Incident toù” codes (HCPCS
codes 99211–99215) were found only in
outpatient claims and were used by 11
individuals. Average reimbursement
amount for these claims was $71.91. Approximately 7% of claims were found on
the carrier file and nearly 100% of these
claims were for influenza and pneumococcal vaccinations. There also existed
geographic variation in the number of
claims across claim files.
Conclusion: Although pharmacists
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APhA2014 ABSTRACTS
are reimbursed by Medicare, this study
found little evidence of pharmaceutical
care being reimbursed through Part A
and Part B. The majority of claims were
for vaccinations and DME. This is likely
to be the case until pharmacists are recognized more widely as providers.
28—REIMBURSEMENT AND FINANCIAL JUSTIFICATION FOR
CLINICAL PHARMACY SERVICES
USING A COMBINATION PHARMACIST-PHYSICIAN VISIT MODEL. Willey V, Lim A, Reinhold J, University of the Sciences–Philadelphia College
of Pharmacy, Willey K, Quality Family
Physicians, E-mail: v.willey@usciences.
edu
Objective: Pharmacists provide direct patient care services in a variety of
settings, however suboptimal payment
is a major barrier to proliferation of these
services. One approach to increase revenue to appropriate levels is to combine
the pharmacist-physician visit and bill
as a single visit under the physician. The
study objective was to describe the revenue generated and determine the feasibility of this billing model.
Methods: A billing record review
was performed on all patients with a
pharmacist-physician visit from August
1, 2012 to July 31, 2013 within a 4-physician, medical home, primary care practice where pharmacists have practiced
since 2009. Pharmacist-physician visits,
which were 1 hour for new patients and
one-half hour for follow-ups, focused
on patients with diabetes, dyslipidemia,
hypertension, pulmonary diseases, and
mental health disorders. Data collected
included the amount paid for visits, diagnosis and procedure codes, and pharmacists’ availability. Outcomes assessed
were overall revenue generated, level of
visit codes, revenue by various visit levels and procedures, and viability of the
business model.
Results: A total of 248 patients
(mean age = 49 ± 17 years; 61.7% female)
had 486 pharmacist-physician visits.
Pharmacists were available for 646.5
hours and total revenue generated was
$43,852 for the 1-year period ($67.83
revenue/hour). Visit coding was 31.6%
for 99213, 68.0% for 99214, and 0.4%
e86 JAPhA | 5 4 :2 | M AR/AP R 2014
for 99215. The mean amount paid was
$66.16 for 99213 visits, $100.06 for 99214
visits, and $154.99 for visits that included
spirometry. Based on a median pharmacist salary (salary.com—October 2013) of
$119,421 ($57.41/hour), revenue generated from this model could meet pharmacist expenses.
Conclusion: Pharmacist-physician
visits billed as a combined visit are a potential way to fund direct patient care
services that pharmacists can provide.
More exploration of this and other business models is needed to see how successful it could be in varying practice
sizes, patient volumes and types, length
of visits, and services provided.
29—ROLE OF OVER-THE-COUNTER
DRUGS IN MEDICAID DRUG UTILIZATION AND EXPENDITURES:
1991 TO 2008. Fikru B, Schondelmeyer
S, Adams D, University of Minnesota
College of Pharmacy, E-mail: fikru002@
umn.edu
Objective: The objective of this study
was to estimate the magnitude of expenditures and claims for over-the-counter
(OTC) drug products in the Medicaid
program from 1991 to 2008. National aggregate experience was examined and
state level variations also were assessed.
Methods: The Medicaid State Drug
Utilization Data from the Centers for
Medicare and Medicaid Services (CMS)
was obtained with utilization data for
each drug within each state by quarter
by year from 1991 to 2008. The CMS data
included expenditures, number of drug
claims, and number of drug units provided to Medicaid recipients. This data
set was assembled, cleaned, and merged
with the Master Drug Data Base (Wolters
Kluwer).
Results: The OTC drug expenditure
in 1991 was $133 million of $4.8 billion
total Medicaid drug expenditures. In
2008 the OTC drug expenditures were
$131 million of $24.3 billion total Medicaid drug expenditures. OTC drugs accounted for 4.4% of claims in 1991, 2.6%
in 2005, and 3.3% in 2008. OTC expenditures were 2.8% of Medicaid drug expenditures in 1991, 0.7% in 2005, and 0.5% in
2008. The average prescription price per
claim was $30.84 for brands, $8.25 for
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generics, and $12.56 for OTCs in 1991. By
2008 the price per claim was $201.52 for
brands, $22.01 for generics, and $12.79
for OTCs.
Conclusion: Since 1975 more than
100 drug entities have been switched
from prescription to OTC status. The
cost per claim for OTCs is well below
the claim cost of the average brand and
generic prescriptions. Brand prescription claims on average cost more than
15-times the average OTC claim. As the
number of blockbuster patented drugs
losing their patents slows, safe and effective OTCs may represent the new focus
of savings in drug benefit and formulary
management for Medicaid and private
health insurance programs.
30—VARIATIONS IN OVER-THECOUNTER DRUG UTILIZATION BY
STATE AND THERAPEUTIC CATEGORY: 1991 TO 2008. Fikru B, Schondelmeyer S, Adams D, University of
Minnesota College of Pharmacy, E-mail:
[email protected]
is to assess variations in the pattern of
utilization of over-the-counter (OTC)
drugs in state Medicaid programs by
state and therapeutic category from 1991
to 2008. State policies related to coverage
of OTC drugs were identified and assessed empirically.
Methods: This was a retrospective
observational study using Medicaid
State Drug Utilization Data reported by
the Centers for Medicare and Medicaid
Services for each state by quarter by year
from 1991 to 2008. This data set was assembled, cleaned, and merged with the
Master Drug Data Base (Wolters Kluwer).
Results: State Medicaid programs
varied considerably with respect to the
share of drug claims and expenditures
for OTC drugs from 1991 to 2008. At the
state level, there were states with <1.0%
of claims for OTCs (e.g., West Virginia,
New York, Idaho). Other states saw
OTCs used for 10% to 15% of the claims
(e.g., Maine, Hawaii, Indiana). The variation in percent of claims as OTC drugs
across the states is wide with more than
10-fold difference between minimum
and maximum percent over this period.
APhA2014 ABSTRACTS
OTCs represented a greater percent of
the gastrointestinal drug claims with the
national average ranging from >16% in
1991 down to 6% in 2008. Topical OTC
products were 4% of the claims in 1991
and rose to >8% of claims by 2008. Other
therapeutic categories including analgesics, respiratory products, nutritional
products, and insulins were examined.
Conclusion: Coverage of OTC
products by Medicaid varies by state
and therapeutic categories. OTC drugs
cost much less than brand name drugs
and even less than generic drugs. OTC
drug products for selective therapeutic
categories may offer an opportunity for
reducing Medicaid drug spending with
safe and effective therapies.
Cardiovascular Care
31—THE ABCS OF HEART HEALTH:
STUDENT SUPPORT OF THE MILLION HEARTS INITIATIVE. Arnall J,
Turingan E, Marciniak M, University of
North Carolina at Chapel Hill Eshelman
School of Pharmacy, E-mail: macary_
[email protected]
Objective: In September 2012 and
March 2013, the National Association of
Chain Drug Stores Foundation sought
proposals from schools and colleges of
pharmacy to host community health
fairs and outreach events. Events should
support the Million Hearts initiative and
the ABCs of appropriate aspirin therapy,
blood pressure control, cholesterol management, and smoking cessation. The
objective of this study is to report on the
impact of this school’s projects to the local community and student pharmacists.
Methods: A planning committee composed of 2 faculty members, 1
cardiology pharmacist, and 20 student
pharmacists was created. Local events
that would reach the targeted patient
populations and health conditions were
identified. Potential sites that could serve
as community partners were contacted.
A list of needed resources and supplies
was developed.
Results: Twelve health fairs were
conducted, serving 507 patients. In total, 39 patients were educated on the
importance of daily aspirin, 187 patients
received blood pressure screenings, 220
patients received cholesterol screenings,
and 79 patients were educated about
smoking cessation. Student pharmacists
made a significant impact on patient
care; 25% of patients screened had an
elevated blood pressure measurement
and 11% were referred for cholesterol
follow-up. Feedback from student pharmacists indicated how participation in
the events positively impacted learning.
The grant funding provided for purchase
of cholesterol testing supplies, a service
that students in the organization had
not previously offered. Students utilized
Million Hearts initiative materials and
created new resources on the ABCs of
heart health and immunizations.
Conclusion: The outcomes of this
initiative demonstrate the impact that a
well-organized and motivated student
pharmacist-led organization can have
on a community. Further, these health
fairs presented opportunities for student
pharmacists to participate in event coordination and direct patient care, which
serve to enhance learning and professional development. Grant funding enabled students to make a positive impact
on their community’s health.
32—COMPARATIVE EFFECTIVENESS OF ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
AND ANGIOTENSIN II RECEPTOR
BLOCKERS IN HEART FAILURE.
Sharma M, Johnson M, Aparasu R, Chen
H, University of Houston, E-mail: manvi.
[email protected]
study were to: (1) determine the comparative effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and
angiotensin II receptor blockers (ARBs)
in patients with heart failure (HF); and
(2) determine comparative effectiveness
of individual drugs within ACEI and
ARB classes.
Methods: A retrospective cohort
study was employed. A national cohort
of Veterans Affairs patients with at least
1 outpatient claim of HF from fiscal year
(FY) 1997 to FY 2002 was identified. The
exposure to drugs was seen in FY 2002
and patients were followed for 1 year to
study the outcome. The main independent variables were ACEI therapy and
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ARB therapy. Outcome assessed was
death. The study adjusted for 45 patient
risk factors including sociodemographics, comorbidities, co-medications and
severity of illness. Multivariate Cox
proportional hazards regression and
propensity scoring techniques were
employed to determine the adjusted estimates of the outcomes associated with
the treatment.
Results: In the cohort of 299,462 patients, 200,552 patients were on either
ACEIs or ARBs; 187,478 patients were
taking ACEIs and 25,987 were taking
ARBs. There was no significant difference in reduction of risk of mortality
with use of ARBs versus ACEIs (hazard
ratio [HR] 0.955, 95% confidence interval
[CI] 0.907–1.006). Results from propensity score analysis also suggest the same.
Among ACEIs, enalapril (HR 0.715, 95%
CI 0.584–0.876), fosinopril (HR 0.778,
95% CI 0.729–0.830), and lisinopril (HR
0.784, 95% CI 0.740–0.831) were significantly better than captopril in reducing
risk of mortality. Among ARBs, candesartan (HR 0.847, 95% CI 0.751–0.994) and
irbesartan (HR 0.892, 95% CI 0.795–1.00)
were significantly better than losartan in
reducing risk of mortality.
Conclusion: Results from the study
suggest that ARBs are equally effective
as ACEIs in reducing risk of mortality
in patients with HF and there are significant differences in effectiveness of individual drugs within ACEIs and ARBs in
reducing risk of mortality in HF.
33—COMPARING
THE
LONGTERM CLINICAL AND ECONOMIC
OUTCOMES OF ATORVASTATIN
AND ROSUVASTATIN FOR MANAGING ELEVATED CHOLESTEROL
IN CLINICAL PRACTICE SETTINGS
USING SIMULATION MODELING.
Balu S, AstraZeneca LP, Folse H, Lee J,
Schuetz C, Archimedes Inc., E-mail: [email protected]
Objective: Using simulation modeling, this study compared the long-term
clinical and economic impact of atorvastatin and rosuvastatin therapy on patients with low-density lipoprotein cholesterol (LDL-C) above Adult Treatment
Panel III (ATP III) goal.
Methods: Two treatment scenarios
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JAPhA e87
APhA2014 ABSTRACTS
were investigated using the Archimedes
model, a clinically detailed simulation
model of human physiology, disease
progression, and health care delivery,
where patients initiated atorvastatin
(10, 20, 40, and 80 mg) or rosuvastatin
(10, 20, and 40 mg), and then periodically intensified treatment or maintained
therapy, per U.S. pharmacy claims-based
rates. Simulated individuals (from the
National Health and Nutrition Examination Survey 1999–2006) were aged 45
to 70 years and had LDL-C exceeding
goal after discontinuing prior prescribed
lipid-lowering therapies. Major adverse
cardiovascular events (MACE; myocardial infarction [MI], stroke, or cardiovascular death) were tracked for 10 years
for the overall population and several
high-risk subpopulations. Event costs
(normalized to 2012 dollars), excluding
pharmacy costs, were estimated using
several sources, including Medicare Current Beneficiary Survey and Medicare
Limited Data Set.
Results: At baseline, the overall
study population (N = 50,000) characteristics were: 56.3% men, mean age
57.2 years, mean LDL-C 162.8 mg/dL,
30% diabetic, and 6.1% with prior MI.
Ten-year relative risks of MACE for rosuvastatin versus atorvastatin were 0.90
(95% confidence interval [CI] 0.89–0.91)
for overall population, 0.88 (95% CI
0.86–0.90) for diabetes mellitus patients,
and 0.89 (95% CI 0.88–0.91) for ATP III
high-risk group patients; all P<0.05. Corresponding 10-year average event costs
per patient were lower for rosuvastatin
as follows: overall $600 (95% CI, $300–
$1,000), diabetes mellitus $800 (95% CI
$500–$1,200), and ATP III high risk $800
(95% CI $400–$1,200); all P<0.05.
Conclusion: In this simulated study,
rosuvastatin treatment reduced MACE
incidence more than atorvastatin over a
10-year period across the overall population and diabetes mellitus and ATP III
high-risk subpopulations, with significant event-related economic (nonpharmacy) savings. Further studies in appropriate statin use among patients with
hyperlipidemia are warranted.
34—DABIGATRAN AND WARFARIN FOR STROKE PREVENTION IN
e88 JAPhA | 5 4 :2 | M AR/AP R 2014
ATRIAL FIBRILLATION: FACTORS
ASSOCIATED WITH USE FOLLOWING NEW MARKET ENTRY IN REAL-WORLD PATIENTS. Lauffenburger J, Farley J, Rhoney D, University of
School of Pharmacy, Gehi A, University
of North Carolina at Chapel Hill School
of Medicine, Brookhart M, University of
North Carolina at Chapel Hill Gillings
School of Global Public Health, Fang G,
University of North Carolina at Chapel
Hill Eshelman School of Pharmacy, Email: [email protected]
Objective: The purpose of this research is to investigate the factors associated with anticoagulant choice in
patients with atrial fibrillation (AF) to
prevent ischemic stroke. Warfarin, the
main therapy choice for decades, has
many safety issues and requires frequent
monitoring. The first alternative, dabigatran, was approved by the Food and
Drug Administration on October 19,
2010. However, the use of dabigatran in
AF is unknown outside of clinical trials
with limited patient diversity. Examining patient, provider, and health-system
factors associated with new use of either
warfarin or dabigatran may allow for
better understanding of factors associated with uptake of newly approved
therapies, influencing comparative effectiveness research.
Methods: A retrospective cohort
study is being conducted using the Truven Health Commercial Claims and Encounters and Medicare Supplemental
Databases from 2008 through 2011. Patients were included if they: (1) received
≥1 inpatient or 2 outpatient AF diagnoses
on separate days (International Classification of Diseases–9th revision diagnosis
code of 427.31) after October 19, 2010;
(2) are aged ≥18 years of age; (3) filled a
prescription for warfarin or dabigatran
following the first diagnosis date; and
(4) maintained continuous eligibility and
had no previous AF diagnosis or warfarin claim in the 12 months prior to the
fill. Factors identified for the analysis included demographic information such
as age, sex, race, geographic vicinity,
type of insurance plan, prescription benefits generosity; clinical data include patient disease history, medication history,
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medication adherence, ischemic stroke
and bleeding clinical prediction risk
scores, and surgical history. Multivariate
log-binomial regression is being used to
investigate whether significant differences are associated with anticoagulant
initiation, adjusting for baseline clinical
Results: Research in progress. In
the 1% sample of the data, 298 newly
diagnosed new users of anticoagulants
meeting the above inclusion criteria were
identified. Further results on the 100%
data are forthcoming.
35—EVALUATION OF THE ANTIFIBRILLATORY DRUG INTERACTIONS BETWEEN AMIODARONE
AND DILTIAZEM IN ISOLATED
PERFUSED RABBIT HEARTS. Almotrefi A, Alhumayyd M, King Saud University, E-mail: [email protected]
Objective: The alarming reports
of the proarrhythmic effects of several
antiarrhythmic agents have stimulated
interest to study the antifibrillatory drug
interactions that may occur when antiarrhythmic drugs from different classes
are combined. Recently, the authors presented the results of interactions between
amiodarone (the prototype of class III
antiarrhythmic drugs) and ibutilide (a
newer drug from the same class) using
the serial-shock method of measuring
ventricular fibrillation threshold (VFT),
a method that have proved reliable in
quantitatively assessing the antifibrillatory potency of many antiarrhythmic
drugs during the last few decades. This
project reports the results of the interactions between amiodarone and diltiazem
as an example of class IV antiarrhythmic
agents.
Methods: Hearts isolated from
New Zealand white rabbits of either sex
weighing 1.5 to 2 kg were perfused by
the Langendorff method with McEwen’s
solution. The method of measuring VFT
and the stimulation connections have
been described in details previously.
Results: Perfusion with either amiodarone or diltiazem produced significant, dose-dependent increase in VFT. In
addition, there was significant difference
in the increase in VFT produced by the
combined infusion of 1 µmol of amioda-
APhA2014 ABSTRACTS
rone and 0.02 µmol of diltiazem and the
summation of the increases produced by
the separate infusion of these 2 concentrations. This is in contrast to the results
of the combined infusion of amiodarone and ibutilide), where no significant
synergistic antifibrillatory effect was
observed. Among the several studies of
different antiarrhythmic drug combinations, this synergistic effect was only observed when lidocaine and propranolol
were perfused simultaneously.
Conclusion: The possible relevance
of these results to their combined use in
the treatment of cardiac arrhythmias is
discussed.
3 6 — P H A R M AC IST-P H YSIC I A N
COLLABORATION IN A SPECIALTY LIPID CLINIC TREATING PATIENTS WITH STATIN INTOLERANCES. Sabato L, Pruchnicki M, The
Ohio State University, Snider M, Sharma
K, Gulati M, The Ohio State University
Wexner Medical Center, E-mail: [email protected]
is to characterize success rates of an interdisciplinary practice model utilizing
physician and pharmacist collaborations
to improve treatment of patients with intolerances to statin medications. The goal
is to characterize the status of patients
referred for statin intolerances and identify regimens associated with successful
rechallenge and continuation as well as
attainment of low-density lipoprotein
(LDL) goal.
Methods: The Comprehensive Cardiac Risk Reduction and Lipid Clinic
at The Ohio State University Wexner
Medical Center treats primary and secondary prevention patients to improve
cardiovascular risk profiles and enhance
lifestyle habits. Patients interact with
physicians and pharmacists at team appointments and at separate pharmacy
clinics. This research will be conducted
as a retrospective chart review of medical records, using a convenience sample
of established patients seen in 3 physician-pharmacist clinics and 3 pharmacist-only clinics during a 1-year study
period (September 2012 to September
2013). All patients with a referral reason
of statin intolerance and/or documented
statin intolerances at the initial clinic appointment and having attended at least
2 follow-up visits in either clinic setting
will be included.
will include patient demographics,
documented history of previous statin
medications and dose, type of adverse
effect(s), and concurrent medications
and medical conditions. Subjects will be
classified as statin users if they were on
a statin and instructed to continue at the
current dose or an adjusted dose at study
visits. Type and dose level of statin will
be described as well as patient status regarding LDL goal attainment according
to the National Cholesterol Education
Program’s Adult Treatment Panel III
guidelines. Descriptive analyses will be
performed to aggregate the data. Continuous variables will be represented using
means and standard deviations, while
categorical data will be represented using percentages and frequencies.
37—PHYSICIANS’ PERCEPTIONS
AND PRESCRIBING HABITS OF
WEIGHT-BASED DIURESIS IN PATIENTS WITH HEART FAILURE.
Murphy E, South Carolina College of
Pharmacy, Newsome R, University of
Georgia, Galdo J, Barney’s Pharmacy,
Brittain K, South Carolina College of
Pharmacy, E-mail: emilyaprilmurphy@
gmail.com
is to evaluate physicians’ perceptions
and prescribing habits of weight-based
diuresis in patients with heart failure.
Methods: The study is a survey of
physicians’ perceptions and prescribing
habits surrounding weight-based diuresis in patients with heart failure. Study
participants will be identified, through
dispensing software at an independent
pharmacy, as physicians who routinely
prescribe loop diuretics. The survey will
be sent electronically to physicians with
an individualized access code, and a reminder e-mail will be sent 14 days after
the initial contact for participants who
did not respond. The survey will obtain
information regarding demographics,
area of practice, drug information utilization, rationale for prescribing weightbased loop diuretics, barriers to prescrib-
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ing, and prescribing habits. The survey
will be conducted from November 1,
2013 through December 31, 2013; physicians may complete the survey only
once.
will be analyzed using statistical analysis
software through the electronic survey
program. All research information will
remain anonymous and in accordance
with the research protocol.
38—PROJECT IMPACT HYPERTENSION: OUTCOMES OF A PHARMACIST-PROVIDED HYPERTENSION
SERVICE. Mariani N, Moser L, Wayne
State University, Nemerovski C, Henry
Ford Hospital, Stutrud C, Wayne State
University, Young M, University Pharmacy, E-mail: [email protected]
Objective: The objective of the study
is to evaluate the impact of pharmacists,
working collaboratively with patients,
on blood pressure control, lifestyle goal
setting, adherence to antihypertensive
therapy, patient knowledge and satisfaction, and modification of cardiovascular
risk factors.
Methods: Self-declared hypertensive patients, identified through a
university wellness plan, met with a
pharmacist for blood pressure monitoring, lifestyle goal setting, and education
about medications and disease state on
4 occasions over a 6-month period. Patients self-monitored using blood pressure cuffs that wirelessly transmitted
data to the pharmacist. Investigators
compared baseline and post-study blood
pressures. Adherence, lifestyle goal setting, knowledge about medications and
disease, and satisfaction with the pharmacy service were determined through
patient self-report and surveys.
Results: Across the population, no
changes were seen in the primary outcome, lifestyle goals, medication adherence, or modification of cardiovascular
risk factors. Patient knowledge increased
from baseline and satisfaction with the
service was high. Subgroup analyses
revealed that those with baseline blood
pressures ≥120/80 mm Hg had a significant decrease in blood pressures and
those not at their goal blood pressure
at baseline had a significant decrease
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APhA2014 ABSTRACTS
in blood pressures and a significant increase in achievement of their blood
pressure goals.
Conclusion: Blood pressure control
improved in patients with a blood pressure ≥120/80 mm Hg or those not at their
treatment goal. All patients increased
their knowledge about hypertension and
reported high satisfaction with the pharmacy service. Pharmacy services should
be offered to patients who are more likely to reap a benefit. Home blood pressure
readings are useful to inform clinical
decision making and supplement patient consultation within the pharmacy
setting.
39—STUDENT-DRIVEN
COMMUNITY
PHARMACY
INTERVENTIONS FOR SCALABILITY OF
THE MILLION HEARTS “TEAM
UP. PRESSURE DOWN.” PIONEER
CHALLENGE. Ellis A, Brown M, Harrell K, Bloodworth L, Ramsey L, Ross L,
University of Mississippi School of Pharmacy, E-mail: [email protected]
Objective: The primary purpose
of this study was to evaluate studentimplemented Tier 1 interventions of
the Million Hearts “Team Up. Pressure
Down.” (TUPD) Pioneer Challenge,
which included increasing awareness
about adherence to medications and
goals in patients with hypertension. The
secondary purposed was to evaluate student interest and confidence in providing community outreach.
Methods: After each spring semester, second professional year (PY2) student pharmacists complete a 2-week
community pharmacy introductory
pharmacy practice experience (IPPE),
typically, as a requirement to implement an original project. In April 2013,
preceptors received TUPD training at
the annual preceptor conference, and
PY2 students received similar training
and blood pressure technique review in
the Skills Lab course. During the IPPE,
students were required to: (1) counsel
patients for antihypertensive prescriptions and emphasize the importance of
adherence, and (2) plan a blood pressure screening and utilize the pharmacist
Drug Adherence Work-Up (DRAW) tool
for appropriate participants. Students
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were assessed both pre- and post-intervention regarding confidence and interest in providing community pharmacy
outreach and completed a reflective essay.
Results: Community pharmacy IPPEs were completed by 71 PY2 students
at 46 sites; they completed a median
of 14.7 patient counseling encounters,
19.2 blood pressure screenings, and 8.7
DRAW tool assessments per student.
A paired sample t test of the pre- and
post-intervention survey showed a statistically significant (95% confidence interval) increase in both student interest
(P = 0.027) and confidence (P<0.001) in
providing community pharmacy intervention events (n = 42). Reflective essays
were primarily positive and included
critical analysis of self-performance in
providing the event, counseling, and
student-initiated modifications to TUPD
provided resources.
Conclusion: Use of the current community pharmacy IPPE structure was
successful in scaling up TUPD interventions and enhancing student-patient
interaction. Increases in student interest
and confidence, and positive feedback
via reflective essays indicated that focused student-driven interventions may
be useful IPPE tools for schools and preceptors.
Collaborative Practice
40—ADVANCING
PROVIDERPHARMACIST TEAM MANAGEMENT OF HIGH BLOOD PRESSURE IN COMMUNITIES. Lickteig C,
Doucette W, University of Iowa, Veach S,
University of Iowa College of Pharmacy,
Carter B, Levy B, University of Iowa, Email: [email protected]
Objective: Control of high blood
pressure (BP) has improved with team
management within clinics; many
communities lack resources to place a
pharmacist in a clinic. The purpose of
this project was to foster provider–community pharmacist teams in small communities to manage high BP using a
team approach. The objectives were to:
(1) conduct team-building activities for
provider–community pharmacist teams
in Iowa and (2) determine the impact of
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the team-building on the development of
a team approach to managing high BP in
the community.
Methods: Providers and community pharmacists in rural and metropolitan communities were contacted
about participating in the project. Once
a provider–community pharmacist team
was recruited, a 1-hour, facilitated, faceto-face team-building session was held
with the practitioners and project team.
Each team-building session discussed
team member roles and activities, identification of patients, and preferred communication modes. A project guide and
resources were given to team members.
For evaluation, baseline and post online
surveys were completed by team members, and redacted BP visit logs were
collected from the pharmacists after 3 to
5 months. Using a multicase approach,
a case report was written for each team,
and cross-case comparisons were made.
Results: Eleven provider–community pharmacist teams participated
throughout Iowa. Each case was rated on
the following criteria: (1) extent to which
they established a system for team management and (2) number of patient connections by community pharmacist for
team BP management. Four teams were
rated as “worked well” (26.5 mean pharmacist BP visits); 5 teams had “limited
success” (6.8 mean pharmacist BP visits);
and 2 teams had “no team approach” (1
mean pharmacist BP visit).
Conclusion: Overall, the project
was somewhat successful in fostering
provider–community pharmacist team
management of BP in smaller communities. Interested stakeholders are encouraged to use such a team building
approach. Future modifications, such
as additional follow-up, could improve
team formation and performance.
41—ASSESSING MEDICAL STUDENTS’ AWARENESS TOWARD
PHARMACIST-PROVIDED COUNSELING SERVICES AND THEIR INTENT TO COLLABORATE USING A
MODIFIED THEORY OF PLANNED
BEHAVIOR. Shah S, University of Georgia, Bechtol R, Pinto S, Stone G, The University of Toledo, E-mail: sshah7@uga.
edu
APhA2014 ABSTRACTS
study are to: (1) assess medical students’
awareness on pharmacist-provided
counseling services; (2) evaluate medical students’ attitude, subjective norm,
and perceived behavioral control (PBC);
(3) assess whether these constructs predict medical students’ intention to collaborate with pharmacists who provide
counseling services; and (4) examine the
relationship between the constructs of
the modified theory.
Methods: A prospective, cross-sectional study design was used involving
first- and second-year medical students
enrolled at the University of Toledo.
An online survey was developed based
on a modified version of the Theory of
Planned Behavior and sent to participants. Data were analyzed using SPSS v.
17.0. Frequency distribution, multiple regression, and Pearson’s correlation were
conducted.
Results: Eighty-seven usable surveys were returned. Nearly 83% of the
medical students were unaware of the
counseling services that pharmacists
provide. Those who wanted to improve
their awareness felt it was important
for building future collaborations and
providing more effective treatment for
patients, and could be enhanced through
workshops and lectures. All of the medical students had positive attitudes toward collaboration. Almost 84% of the
medical students did not feel any social
pressure to collaborate with pharmacists. Nearly 95% of the respondents felt
that collaborating with pharmacists providing counseling services was not difficult for them. Regression results showed
that subjective norm (beta = 0.059;
P<0.05) and PBC (beta = 0.130; P<0.05)
were significant predictors of intention.
A moderate positive correlation existed
between all the constructs.
Conclusion: In order to increase the
intent of medical students to collaborate with pharmacists, it is important to
raise awareness along with a positive
attitude, high subjective norm, and high
PBC. Although subjective norm and PBC
predicted intention, unawareness was
found to be a noteworthy barrier at this
stage in their educational career. Efforts
should be made toward raising aware-
ness through interprofessional workshops and classroom lectures in medical
school.
42—AN ASSESSMENT OF PHARMACIST-PROVIDED
MEDICARE
ANNUAL WELLNESS VISITS IN AN
INTERNAL MEDICINE PRACTICE.
Musselman K, Kelly D, Bon Secours
Medical Group, E-mail: [email protected]
study were to: (1) increase number
of Medicare annual wellness visits
(AWVs); (2) develop reimbursement
strategy for pharmacist services; and (3)
assess health outcomes and recommendations identified during AWVs.
Methods: A retrospective chart review was completed for program evaluation of new service procedure, piloted
over 6 months. A pharmacist employed
by a medical group provided initial
Medicare AWVs to Medicare beneficiaries at an internal medicine practice under a collaborative practice agreement.
Patients were referred by physician and
staff for a 45-minute appointment scheduled a half day every other week based
on availability of the pharmacist, physician, and exam room. An AWV template
was utilized for visit documentation.
During the visit, the pharmacist identified health outcomes; medication-related problems (MRP) based on Hepler and
Strand, preventive screenings based on
U.S. Preventive Task Force, and recommended immunizations based on Advisory Committee on Immunization Practices. The physician billed the visit and
was consulted as appropriate.
Results: Of the 41 AWVs performed
over 6 months, 20 were performed by the
pharmacist. Six months prior, 4 AWVs
were performed. Eleven additional preventive care screenings were identified
and ordered based on collaborative practice agreement. Twelve MRPs were identified; 8 recommendations were accepted
in collaboration with the physician. Sixteen immunizations were recommended; 14 immunizations were accepted and
administered by the pharmacist during
visit or given a prescription. Twenty-five
percent of the initial AWV reimbursement covered the pharmacists’ time.
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Conclusion: The pilot enhanced patient care utilizing a multidisciplinary
approach. The pharmacist increased the
number of AWVs provided during the
pilot. Patient care was enhanced as additional preventive care, MRPs, and immunizations were identified. As a result,
AWVs will be conducted by the pharmacist for all providers in the office. Moving forward, 2 additional pharmacists
are being hired to assist with Medicare
AWVs in practices affiliated with the
medical group.
43—IMPACT OF A COMMUNITY
PHARMACY
SPECIALTY
PROGRAM FOR THE TREATMENT OF
PATIENTS WITH RHEUMATOID
ARTHRITIS. Newsome R, University
of Georgia, Murphy E, South Carolina
College of Pharmacy, Galdo J, Bourgh
C, University of Georgia, E-mail: [email protected]
Objective: The aim of this study
is to determine whether a community
pharmacy specialty program for patients
with rheumatoid arthritis (RA) results in
a change in disease severity based on Patient Activity Scale-II (PAS-II) score.
Methods: A retrospective chart review will be conducted evaluating the
clinical outcomes of a specialty program
at an independent pharmacy. The RA
specialty program is offered to all patients with RA, as determined by prescription history and confirmation of
diagnosis of RA. All patients using the
service will be eligible for inclusion in the
study. The specialty program consists of
administering the PAS-II to determine
disease severity, assessing current pharmacotherapy and side effects, calculating medication adherence based on the
medication possession ratio, and then
contacting the prescriber via fax with the
information obtained and recommendations to provide continuity of care. The
study is comparing the clinical outcomes
at baseline to 3 months after initiation of
the specialty program.
primary endpoint will be change in disease activity based on PAS-II score after
3 months. Ordinal data from the PAS-II
will be analyzed using the Wilcoxon
signed-rank test. Secondary endpoints
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will include change in medication adherence, pharmacotherapy, and patientreported medication side effects. Results
of this service could indicate the ability
of independent pharmacies to become
more involved in specialty disease states
such as RA. Furthermore, results could
show the clinical benefit of pharmacistled disease assessment.
44—IMPACT OF AN INTERPROFESSIONAL SERVICE-LEARNING
ELECTIVE COURSE ON HEALTH
PROFESSIONAL
STUDENTS’
ACHIEVEMENT OF INTERPROFESSIONAL EDUCATION COLLABORATIVE COMPETENCIES. Sevin
A, Hale K, McAuley J, The Ohio State
University College of Pharmacy, E-mail:
[email protected]
is to investigate the effectiveness of an
interprofessional (IP) service-learning
elective course involving patient care in
underserved populations for improving
health professions students’ confidence
in Interprofessional Education Collaborative competencies.
Methods: This study evaluates pharmacy, nursing, and social work students
at the completion of an IP service-learning course involving patient care in underserved populations. The course consists of: (1) a service component where
students provide patient care in an IP
student-run free clinic; and (2) workshops in which students reflect on their
experiences and discuss roles, team dynamics, communication skills, and challenges with underserved patient populations in IP groups. All students enrolled
in the course (approximately 30) will be
invited to complete a previously validated, 42-question survey in a retrospective post-test then pre-test design (i.e.,
at the conclusion of the course, students
will assess themselves on each competency and reflect back to assess their
proficiency in each competency prior to
participating in the course). The survey
instrument assesses Interprofessional
Education Collaborative competencies
in four domains: values and ethics, roles
and responsibilities, IP communication,
and teams and teamwork. Data also will
be collected relating to participant de-
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mographics and previous IP experience.
Descriptive statistics will be generated
for each survey item with responses expressed using frequencies and percentages, and a paired t test will be utilized
to compare differences in post- and retrospective pre-test scores.
Results: Research in progress. Results are expected to provide evidence
of the impact of an IP service-learning
course on students’ confidence in their
abilities to practice as a part of an IP
team. As IP competencies are incorporated into educational accreditation standards, health professions schools will
need to identify effective ways to achieve
those competencies.
45—IMPLEMENTATION OF A MEDICATION RENEWAL PROTOCOL
AT COMMUNITY PHARMACIES
WITHIN AN ACADEMIC MEDICAL CENTER. Weaver A, Hartkopf K,
Goldrosen K, University of Wisconsin
Hospital and Clinics, E-mail: aweaver@
uwhealth.org
study are to: (1) implement a medication renewal protocol (MRP) at 11 community pharmacy sites; (2) decrease
patient wait times for medication renewals at community pharmacies through
implementation of the MRP; and (3)
evaluate health care provider perspectives of pharmacist involvement in the
MRP. The MRP has been approved by
the medical board within the academic
medical center and allows pharmacists
to renew chronic medications under authority of a physician if specific criteria
are met. Patient-specific criteria include
appropriate and up-to-date laboratory
values and a recent office visit with the
prescribing provider. Pharmacists at this
organization have not yet implemented
the MRP. Consequently, patients who
present with no refills on a prescription
cannot receive the full medication quantity until the physician’s staff respond to
a fax request.
Methods: This pre- and post-implementation study will occur in 11 community pharmacies within an academic
medical center. Stakeholder meetings
will be held to determine how to operationalize the MRP across the community
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pharmacy sites. Stakeholder members
will include physicians, pharmacists,
pharmacy technicians, clinic managers,
nurses, and medical assistants. Standardized educational training and materials will be developed and presented
to community pharmacists. Educational
training will emphasize the medications
included in the MRP, how to re-order
these medications, and procedures for
documentation. Pre- and post-implementation data collected from the pharmacy dispensing system software and
electronic medical records will be used to
calculate the time required to complete
prescription renewal requests. Additionally, pharmacy staff will collect data on
the number of prescriptions included in
the MRP that present to the pharmacy
without refills. An anonymous, post-implementation survey will be sent to pharmacists and other health care professionals impacted by the MRP to evaluate
perspectives of pharmacist involvement
in the MRP.
46—MEDICATION MANAGEMENT
PROGRAM IN PEDIATRIC PATIENTS WITH ASTHMA: A COMMUNITY PHARMACY AND CHILDREN’S HOSPITAL MEDICAL CENTER PARTNERSHIP. Bradley C, Luder
H, University of Cincinnati/Kroger
Pharmacy, Bowen R, Kroger Pharmacy,
Heaton P, University of Cincinnati James
L. Winkle College of Pharmacy, Frede
S, Kroger Pharmacy Cincinnati-Dayton
KMA, Kahn R, Beck A, Cincinnati Children’s Hospital Medical Center, Mansour M, Cincinnati Children’s Hospital
Medical Center, E-mail: [email protected]
is to implement a collaborative asthma
management program consisting of
counseling and medication management
targeting pediatric patients with uncontrolled asthma in a community pharmacy. This study aims to determine the
impact of this service on 30-day hospital
utilization rates, 90-day hospital utilization rates, number of primary care physician visits, and asthma control.
Methods: Numerous community
pharmacy asthma programs demon-
APhA2014 ABSTRACTS
strated improved asthma control; however, there are limited and contrasting
results in pediatric patients and in transitions of care. Furthermore, there is no
evidence of pharmacist and physician
collaboration to establish continuity
of care in this setting. A collaboration
will be formed between a large grocery
store chain community pharmacy and
a children’s hospital medical center to
proactively identify patients with uncontrolled asthma. Information from asthma
control tests, refill history, and recent
health care utilization will be used to
form a targeted list of patients. Community pharmacists will target these jointly
identified patients at the pharmacy and
provide an educational and medication
management service. Counseling will be
provided as patients present to the pharmacy and will focus on general asthma
education, appropriate directions and
administration of asthma medications,
and environmental triggers. All counseling topics and handouts will contain
similar educational messages received
at the children’s medical center to ensure
continuity of care. Pharmacists will fax
a summary report to the physician with
specific medication recommendations.
Pharmacists will follow-up in 30 days to
assess asthma control, provide additional education, and propose further recommendations as appropriate. To assess
this intervention, aggregate data will be
evaluated in a pre-post design. The children’s hospital medical center will offer
data on hospital utilization rates and
physician visits. The community pharmacy will assess asthma control. The results will be analyzed by descriptive and
inferential statistics as appropriate.
47—PATIENT-REPORTED DIABETES SELF-EFFICACY AND SATISFACTION WITH CARE IN A PRIMARY CARE SAFETY NET CLINIC.
Hurley K, Western University of Health
Sciences, Wang A, Pomona Valley Hospital Medical Center, Hess K, Western
University of Health Sciences, E-mail:
[email protected]
Objective: The primary objectives
of this study are to: (1) measure patients’
self-efficacy regarding their ability to
effectively participate in their diabetes
care; (2) evaluate patient satisfaction
with their medical care at this clinic; and
(3) examine correlations between patient
self-efficacy, satisfaction, and clinical
and demographic variables. Secondary
objectives include describing the clinical pharmacy operations at this site and
the types and frequency of interventions
made.
Methods: In an effort to further
promote safe and effective medication
use, clinical pharmacy services were
recently incorporated into an existing
primary care safety net clinic. A descriptive background review of clinical pharmacy functions and operations at this
clinic will be completed concurrently
with a prospective patient survey. The
Perceived Diabetes Self-Management
Scale will be utilized along with questions from a separate validated patient
satisfaction survey to measure diabetes
self-efficacy and satisfaction. Beginning
January 2014, surveys will be administered to approximately 300 patients by
clinic staff immediately following patient appointments. Responses will be
stratified by patient demographics (e.g.,
age, sex, ethnicity) and whether the patient saw a clinical pharmacist and/or
another provider (i.e., physician, nurse
practitioner, physician’s assistant). All
data will be collected in Excel databases.
Statistical analysis of the background
review will consist of proportions and
means to document interventions made
while survey data will be analyzed using Pearson’s correlation and t tests to
examine the relationships between selfefficacy, A1C, number of comorbidities,
number of medications used, and other
patient demographics.
48—PROVIDER RESPONSE RATE
TO PHARMACIST FAXED INTERVENTIONS AND THE IMPACT ON
PATIENT OUTCOMES IN AN UNDERSERVED POPULATION. Risner
J, Hall L, The Ohio State University,
Seifert J, Pharmaceutical Horizons, Porter K, The Ohio State University, E-mail:
[email protected]
is to evaluate provider response rate to
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community pharmacist faxed medication interventions from Charitable Pharmacy of Central Ohio (CPCO), which
provides medications at no cost to an
underinsured and uninsured population. Patients at CPCO endure barriers
involving finances, literacy, and transportation making it difficult to obtain
optimal, routine health care. Without
routine care, their visit to the community
pharmacy may be their primary contact
with a health care professional. At CPCO, prescribers are frequently contacted
via fax or phone to provide clinical information and request medication changes
to improve the health of patients. The
primary objective is to determine provider response rate to pharmacist faxed
interventions. The secondary objective is
to analyze the effect of faxed pharmacist
interventions on clinical outcomes, specifically blood pressure (BP) and blood
glucose (BG).
Methods: This study will be conducted as a retrospective chart review.
All patient charts at CPCO will be reviewed for faxed interventions (approximately 3,500 charts). Provider response
rate, within 3 months, to these interventions will be recorded along with type of
intervention requested. A subset of interventions and outcomes will be examined, involving BP and BG. Patient clinical status will be analyzed before and
after faxed interventions to determine if
an accepted intervention (versus not accepted or no response) corresponds to a
positive clinical response. A percentage
(number of responses/number of interventions) will be used to report provider
response rates, while comparison of
BP and BG will be analyzed using chisquare and/or t test.
Results: Research in progress. By
evaluating provider response rates to
pharmacist faxed interventions, a potential barrier found in underserved populations may be elucidated. Secondary
measures may quantify benefits of pharmacy services in this population. Overall, results may lead to discussion on
how to better collaborate as health care
professionals to serve these individuals.
Communication/Patient Education
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49—ASSESSMENT OF COMMUNITY
PHARMACIST–PROVIDED
EDUCATION ON PATIENT KNOWLEDGE AND BEHAVIORS REGARDING PHARMACOLOGIC AGENTS
THAT CAUSE DRY MOUTH. Elswick
B, Baugh G, Scott V, West Virginia University School of Pharmacy, E-mail: [email protected]
project were to: (1) educate pharmacists
and patients on the role of dry mouth
and dental decay; and (2) enhance the
dentist-pharmacist-patient relationship.
Methods: An open-enrollment
study was conducted at 5 community
pharmacies across a wide geographic
area. Prior to study implementation,
pharmacists completed an online educational self-study module and quiz; 2
optional educational sessions were conducted at state pharmacist conventions.
Participants were community pharmacy
patrons identified as taking medications
that could cause dry mouth. Pharmacists
provided education to participants on
dry mouth, poor dental health, potential
treatment strategies, or referred them to
their dentist. Participants completed a
questionnaire about their personal risk,
knowledge, and self-treatment of dry
mouth pre- and post-education.
Results: Nearly 80% of all participants (n = 142) indicated that they suffered from dry mouth. Participants reported symptoms such as chapped lips
(52%), gastrointestinal problems (32%),
and bad breath (24%). Nearly one-third
of participants reported having used a
product to treat dry mouth. Self-treatments included water (6%), dry mouth
symptom relief products (4%), and gum
or mouthwash (2% each). Participants indicated an increase (41%, 41% vs. 82%) in
overall knowledge of medication-related
dry mouth in post–pharmacist education. Whereas, an even greater percentage of participants (57%, 28% vs. 85%)
noted an increase in their knowledge
regarding strategies available to treat
dry mouth and the relationship between
dry mouth and dental decay following
education. It was unclear what effect
pharmacist-provided education had on
referral rates for additional dental care.
Conclusion: Dry mouth is a poten-
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tial adverse effect of over 400 medications and a leading cause for dental
caries in the United States. Community
pharmacists have an important role in
identifying risk for drug-induced dry
mouth and provide valuable self-treatment recommendations. More research
and initiatives are needed to increase the
interprofessional relationship between
community pharmacists and dentists.
50—ASSESSMENT OF PATIENT
PERCEPTIONS OF STUDENT-RUN
HEART AND DIABETES PATIENT
OUTREACH INITIATIVES. Wei A,
Uppala A, Banda S, Lin M, Cheng S, Rubino A, Shah K, Feudo D, Ernest Mario
School of Pharmacy, Rutgers University,
Objective: Current challenges in
medication adherence and general disease state knowledge for hypertensive
and diabetic patients prompted the
creation of student initiatives to reach
the community. However, the impact
of such student initiatives has not been
evaluated. The objectives of this project
are to: (1) identify the impact of studentrun patient care outreach initiatives at
local events at department stores and
senior centers on patients’ overall knowledge of prevention and management of
hypertension and diabetes; and (2) identify areas of improvement for studentrun patient care outreach initiatives.
Methods: For each of the 2 studentrun patient care initiatives, operation
heart and operation diabetes, 6-question
surveys will be divided into multiplechoice style with 3 pre-screening and 3
post-screening questions. The questionnaires are divided into the following categories: knowledge-based (about hypertension or diabetes), lifestyle modification (maintain normal blood pressure or
glucose levels), screening, and perceived
impact of event. Participants will be
asked to sign informed consent and answer the pre-screening questions initially. Then, they will be screened for blood
pressure and/or glucose levels and educated via posters about sodium intake,
carbohydrate monitoring, and healthy
lifestyle changes. Immediately afterward, they will be prompted to answer
the post-screening questions to evaluate
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their knowledge after the screening and
education process. Students with institutional review board (IRB) approval will
distribute IRB-approved surveys on site
during several events from October 2013
to March 2014. Inclusion criteria include
participants who are literate English
speakers, sign informed consent, are ≥18
years of age, and are willing to complete
the survey. Participants who do not complete each question in both the pre- and
post-surveys will be excluded. Results
will be analyzed to compare any trends
between the pre-screening questions and
corresponding post-screening questions.
The implication of the results will demonstrate the overall effectiveness and any
areas of improvement.
51—CHUNK AND CHECK: PHARMACISTS’ ORGANIZATION AND
EVALUATION OF PATIENT EDUCATION. Margolis A, Martin B, University
of Wisconsin–Madison School of Pharmacy, E-mail: [email protected]
Objective: New information is best
learned in small chunks with brief assessments or checks. The objective of this
study was to observe pharmacists’ primary method for organizing or “chunking” patient medication information and
checking patient understanding.
Methods: This qualitative study observed 6 pharmacists performing new
and renewal medication consultations
for 55 patients. Patient consultations for 3
inpatient and 3 community pharmacists
were observed by the investigator and
were audiotaped. The tapes were transcribed and coded to uncover common
themes, consultation chunk patterns,
and examples of pharmacists’ checking
technique. The frequencies of techniques
were tallied by pharmacist; descriptive
statistics and chi-square were used when
appropriate.
Results: The 3 major chunk patterns
were: time of day the medication should
be taken, education by each medication,
and the 3 prime questions. Inpatient and
community pharmacists used different
chunk patterns when performing patient education. Inpatient pharmacists
were more likely to vocalize their organizational structure to the patient (P =
APhA2014 ABSTRACTS
0.002 compared with community pharmacists). Both inpatient and community
relied heavily on informal evaluation or
checking (85.7% and 40.7% respectively,
P = 0.001). Inpatient pharmacists were
more likely to formally assess patient
understanding and used higher level
check techniques that promoted patient
problem solving (46.4% and 3.7% respectively, P <0.001).
Conclusion: Pharmacists should
verbalize the way they plan to chunk or
organize their consultation to help orient the patient to the education plan and
improve patient understanding. The
complexity of the medication consultation may drive the primary chunking
pattern the pharmacist uses. Formal assessment of patient understanding was
minimal, however all pharmacists consistently used final checks. Even among
pharmacists who excelled at evaluation,
techniques to encourage patient problem
solving and vocalization of directions
could enhance learning. Additional research is needed to evaluate the effect of
chunk and check on patient retention of
medication information and patient outcomes.
52—DEVELOPMENT OF A COMPREHENSIVE COMPETENCY RUBRIC FOR EVALUATING PHARMACY STUDENT SELF-CARE COUNSELING. Franz T, Thornton P, Chen A,
Fox N, Frame T, Cedarville University,
Objective: The aim of this study is to
create and evaluate a comprehensive rubric assessing student pharmacists’ ability to counsel patients on self-care topics.
Methods: Assisting and counseling
patients on appropriate self-care use is a
significant component of pharmacy, especially in community practice. A review
of the literature did not find a satisfactory
assessment tool to evaluate students’
ability to apply self-care knowledge
when counseling patients. A rubric was
developed for faculty to evaluate students’ interpersonal skills and clinical
knowledge in simulated patient encounters, with an abbreviated rubric developed for pharmacy preceptors to assess
counseling during practice experiences.
The rubric was created from an extensive
review of the literature and underwent
comprehensive review by student pharmaicsts and faculty with expertise in selfcare, assessment, and scale development
to establish content and face validity. The
final faculty rubric contained 14 items
(4-point, Likert-type [1 = unsatisfactory;
4 = commendable]); 7 of the items were
on interpersonal skills (e.g., attitude, empathy, professionalism) and 7 items were
on appropriate self-care counseling (e.g.,
QuEST SCHOLAR-MAC, self-care candidacy, teach-back method). The abbreviated preceptor rubric contained 5 items
(1 interpersonal and 4 self-care).
Faculty rubric validation will be obtained in 10 simulated encounters with a
faculty rater. A select number of encounters will be recorded, reviewed, and rated by a team of faculty for further validation. Preceptor rubric validation will be
obtained in 10 actual patient encounters
during weekly practice experiences. The
instrument will be assessed for internal
consistency, inter-rater reliability, and
intra-rater reliability.
collection is in progress with 3 simulated
and actual encounters completed for 47
students. Preliminary reliability analyses from the first encounter provided
a Cronbach alpha of 0.752 and 0.751 for
the faculty and preceptor scales, respectively. While removing a few individual
items (3 items faculty, 1 item preceptor
scale) would lead to a slightly higher
Cronbach alpha, removal does not lead
to a Cronbach alpha >0.78.
53—DEVELOPMENT OF A COUNSELING SERVICE BY THE PHARMACY TEAM TO OVERCOME
WORSENING SIDE EFFECTS RELATED TO HEPATITIS C MEDICATIONS IN A U.S.–MEXICO BORDER
COMMUNITY HEALTH CENTER.
Heredia G, Sias J, University of Texas
at El Paso, Kelly J, Lucero A, Centro de
Salud Familiar La Fe Inc., E-mail: [email protected]
Objective: The purpose of this project is to pilot an interdisciplinary hepatitis C virus (HCV) counseling service
based out of the community health center pharmacy for a predominantly Mexican-American population. By the end of
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the pilot phase of this project, the study
will: (1) identify perceptions, barriers,
and fears related to HCV and treatment
in a pilot group of subjects; and (2) develop pharmacy tools that expand on current HCV services (for approximately 30
patients) to enhance counseling and side
effect management from the community
pharmacy team. Studies have found that
a common reason patients decline or prematurely discontinue HCV treatment is
due to medication side effects.
Methods: Initial steps to develop
this service include conducting a literature search about HCV, side effect management, and patient perceptions of the
disease. Part of the project includes collecting demographic information and
employing qualitative methods using
a semi-structured interview (open- and
close-ended) in English and Spanish in
a subset (n = 10) of adult patients with
HCV infection at the community health
center. The interview process, which is
board and based in the Health Belief
Model and Kleinman’s Patient Explanatory Model, is designed to give the pharmacist more detailed insight into patient
concerns and will be conducted from
December 2013 through March 2014. Descriptive statistics and a summary report
of interviews, as well as findings from
literature search and guidelines, will be
used to aid in the creation of counseling
tools in English and Spanish. Other pharmacy tools to be created include a guide
for the pharmacist to counsel on appropriate injection technique, side effects
of medications used to treat HCV, and
management. Patient consultation tools
focusing on side effect management,
over-the-counter, and nonpharmacologic recommendations also will be created.
54—DEVELOPMENT OF HEALTH
COACHING SKILLS TO ENHANCE
STUDENT PHARMACISTS’ COMMUNICATION TECHNIQUES. Middendorf A, Veach S, University of Iowa
College of Pharmacy, Tonn M, Shen R,
CarePro Health Services, Catney C, Tien
Y, University of Iowa College of Pharmacy, E-mail: [email protected]
Objective: The aim of this project
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APhA2014 ABSTRACTS
is to develop and implement a series of
learning modules for advanced pharmacy practice experience (APPE) students
that focus on enhancing specific health
coaching skills and demonstrating those
skills with case-based simulated patient
encounters. The Accreditation Council
for Pharmacy Education highlights the
importance of communication-related
competencies for pharmacy graduates.
Health coaching is a method of communicating with patients where practitioners work with and empower patients
to become active participants in their
own care. Pharmaceutical care services
offered at community pharmacies offer
opportunities for APPE students to put
health coaching skills into practice.
Methods: Evidenced-based learning modules to enhance health coaching
skills for APPE students will be developed and implemented as part of each
APPE rotation cycle at 2 small chain community pharmacies. A literature review
of essential health coaching skills necessary for pharmacists will be conducted
to aid in the development of learning
modules. Examples of possible module
topics include the transtheoretical model
of change, motivational interviewing,
and coaching styles. Learning modules
will consist of interactive reading-based
assignments followed by simulated patient cases to demonstrate specific skills.
Cases will be adapted from the American Pharmacists Association’s PharmacyLibrary to present opportunities
for the student to demonstrate specific
skills and for the preceptor to provide
interactive feedback. Medication therapy
management, diabetes education, wellness screening consultations, and other
pharmaceutical care services available at
the community pharmacy sites will provide opportunities for APPE students to
incorporate what they learn through the
health coaching modules into real-world
patient interactions. The development
and implementation of this project will
be described and barriers or limitations
will be identified.
Crane L, O’Neal K, Honey B, Crosby K,
University of Oklahoma College of Pharmacy and Health Sciences Center–Tulsa,
Objective: According to the Centers
for Disease Control and Prevention, in
2010, 18.7 million adults had a diagnosis of asthma. In 2008, asthma caused
14.2 million missed days of work. To
help manage and improve outcomes of
this chronic disease, it is imperative that
patients receive education on self-management and interventions to reduce
modifiable risk factors. However <7 out
of 10 adults are taught how to recognize
asthma symptoms, and <1 out of 3 adults
get an asthma action plan from their
health care provider. The objective of this
study is to assess and compare disease
state knowledge, asthma control, and
self-management skills in adults with
asthma.
Methods: This will be a pilot study
enrolling 30 to 60 adult patients seen
within an internal medicine ambulatory
care clinic. Patients with a documented
diagnosis of asthma will be selected to
participate. Patients will be administered
an asthma knowledge questionnaire and
the Asthma Control Test. In addition,
the patient’s inhaler technique will be
assessed using a predefined checklist of
steps. Descriptive statistics will be used
to analyze the data collected.
primary outcome of this study is to determine whether there is any comparison
between asthma knowledge and selfmanagement skills in adults. It is thought
that a lack of knowledge exists in the
adult population, which contributes to
asthma that is not well-controlled. Consequently, there may be an opportunity
for increasing and raising awareness of
the need for asthma education in this
patient population. Study results may
show an opportunity for pharmacists
to get involved in adult asthma education. This evidence would be useful in
presenting collaborative practice ideas
to other health care providers and thirdparty payers.
55—DISEASE STATE KNOWLEDGE
AND SELF-MANAGEMENT SKILLS
FOR ADULTS WITH ASTHMA.
56—EVALUATION OF MERCK’S
HEADACHE SCHOOL: A QUASIEXPERIMENTAL EXAMINATION
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OF EFFECTIVENESS. O’Neal K, University of Oklahoma Health Sciences
Center–Tulsa, Murray K, University of
Oklahoma, Desselle S, California Northstate University, Weisz M, University of
Oklahoma Health Sciences Center–Tulsa, E-mail: [email protected]
Objective: The objectives of this research were to: (1) evaluate the school for
its perceived utility among migraineurs
and accompanying pharmacist-tailored medication session; (2) determine
whether the school and/or addition of
a pharmacist are associated with self-efficacy in migraine management, behaviors, and improvement of outcomes; and
(3) identify any intervening variables in
the “Headache School” utility.
Methods: Three-group, quasi-experimental design was employed in this
study. Patients were recruited from the
Tulsa and Oklahoma City metropolitan
area if they had a migraine diagnosis.
Group 1 served as a control. Group 2 was
enrolled in the Headache School. Group
3 was enrolled in the Headache School
and received a pharmacist-tailored
medication session. All groups were surveyed at baseline for self-efficacy in migraine management behaviors, knowledge, and Migraine-Specific Quality of
Life (MSQ). Groups 2 and 3 also were
surveyed at 1 month and all 3 groups
surveyed again at 3 and 6 months.
Follow-up surveys included questions
regarding the Headache School. Statistical analyses will include descriptive statistics (patient perceptions), inferential
statistics (Headache School association
with self-efficacy, migraine knowledge,
management behaviors, and MSQ), and
Cronbach alpha (internal consistency
reliability and psychometric suitability).
Additionally, analyses will be done to
determine if observed differences are
sustained/improved at the 6-month interval. This project has been approved by
the institutional review board.
120 patients recruited were evenly distributed into groups. Baseline results
show that only 10% of patients rated
themselves as completely confident in
migraine trigger management. Fiftythree percent answered all 9 knowledge
questions correctly. With the MSQ, <10%
APhA2014 ABSTRACTS
of patients responded they did not have
migraines that impacted their quality of
life or did not have a migraine in the preceding 4 weeks implying that the majority of patients had some degree of a debilitating migraine.
57—IDENTIFYING COMMON BARRIERS AND DEVELOPING STRATEGIES TO IMPROVE COUNSELING
SKILLS OF DOCTOR OF PHARMACY STUDENTS WHOSE FIRST
LANGUAGE IS NOT ENGLISH. Oh
S, Massachusetts College of Pharmacy
and Health Sciences University, E-mail:
[email protected]
Objective: This study seeks to address the most common barriers that
English as Second Language (ESL) students encounter during counseling and
to identify the effective educational
methods to overcome those barriers.
Methods: The study subjects are
student pharmacists completing their
first professional year (P1) and entering
their second professional year in an accelerated doctor of pharmacy program.
A group of ESL students who are not
participating in the study will serve as
a direct control group, and the data also
will be compared with the data from all
P1 students regardless of their first language. At the first meeting, initial selfevaluation will be conducted. Each student will make an appointment for the
first patient counseling activity. One preceptor and 1 advanced pharmacy practice experience student will attend the
counseling session, then will complete
the evaluation forms afterward. Both
preceptor/peer and self-evaluations
will consist of 5-point Likert scale–type
questions, and each question will have a
comment box for a more elaborated description. The focus will be on styles of
communication, mannerisms, and interactions rather than the content of counseling. Use of appropriate nonverbal
communication, pace, flow, transition
and patient-friendly specific language
use will be evaluated.
Results: Research in progress. Recruitment begins on November 12, 2013,
and the data collection/analysis period
is through May 12, 2014. The data will
be analyzed using descriptive statistics.
Verbal communication skills of pharmacists are a vital component to effective
pharmacy intervention. The number
of ESL students in pharmacy school is
increasing rapidly, and those who lack
acceptable counseling skills will not interact with patients effectively. The findings of this study will help in identifying
unique challenges that ESL students encounter during counseling and developing tactics for those students to overcome
such challenges.
PHARMACIST IN RESOLVING
MEDICATION-RELATED
CARE
GAPS FOR A COMMERCIALLY INSURED PATIENT POPULATION. On
P, AccessCare, Pfeiffenberger T, Community Care of North Carolina, Lundeen
K, Scott J, Branski S, AccessCare, Watkins R, Community Care of North Carolina, E-mail: [email protected]
Objective: While studies exist that
evaluate the impact of ambulatory care
pharmacists in resolving medicationrelated care gaps, little has been said
about the effectiveness of the community
pharmacist. The primary objective of
this study is to evaluate the effectiveness
of interventions made by a community
pharmacist to close medication-related
care gaps for a commercially insured
patient population. The secondary objective is to describe the types of interventions made by a pharmacist that are most
successful in resolving care gaps.
Methods: This quasi-experimental
study will be submitted to the institutional review board for approval. The
community pharmacist will review a
list of alerts provided by a commercial
payer to identify patients with at least
one medication-related care gap. Medication-related care gaps include the need
for drug monitoring and/or the addition
of medication(s) to meet the standard
of care. Care gaps that are determined
by the pharmacist to already be closed
will be excluded. The pharmacist will
communicate with the patient regarding the care gap and provide education
as needed. Additionally, the pharmacist
will provide recommendations to the
patient and/or primary care provider
in an attempt to close the identified care
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gap. Recommendations may include
drug monitoring and/or the addition of
medication(s) needed to meet the standard of care. As appropriate, the pharmacist may communicate with other
health care professionals needed to close
the care gap. Patients will be referred to a
care manager as needed for care coordination. The following data will be collected: categories of medication-related care
gaps, types of interventions used by the
pharmacist, provider acceptance of the
pharmacist’s recommendations, and/or
actions taken by patients that close the
care gaps. Success rates will be measured
by closure of care gaps within 60 days after the pharmacist’s interventions. Data
will be analyzed using descriptive statistics.
59—IMPACT OF STUDENT PHARMACIST–LED INTERACTIVE SESSIONS ON PATIENT HEALTH LITERACY. Laliberte B, Gillis C, Taglieri
C, Matthews M, Massachusetts College
of Pharmacy and Health Sciences University, E-mail: benjamin.laliberte@
my.mcphs.edu
Objective: Pharmacists’ impact on
patient care is clearly documented. As future health care providers, student pharmacists are encouraged to participate in
community service activities. However,
there is a lack of data to assess the full
impact of student pharmacist community engagement. The objective of this
study is to quantitatively assess patients’
comprehension of health-related topics
before and after a 1-hour student-developed and directed interactive session,
and the impact of the utilized open discussion format.
Methods: A prospective, crosssectional study was conducted during 3
sessions in the Boston area from November 2012 through March 2013 on topics
chosen by each site: hypertension at the
South Boston Neighborhood House, hyperlipidemia at the ABCD Parker Hill/
Fenway Center, and nutrition at the
Cambridge Senior Center. All attendees who completed pre-session surveys
were included. Surveys were composed
of a 5-point categorical Likert scale (1 =
strongly disagree; 5 = strongly agree).
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APhA2014 ABSTRACTS
Microsoft Excel was employed to calculate statistics and 2-sided t tests. The primary endpoint was the change in overall
mean survey score. Secondary endpoints
included change in individual question
means and cumulative patient feedback
score.
Results: Because some attendees arrived after pre-session surveys were collected, 27 of 50 attendees were included.
Overall mean scores increased post-survey from 4.085 to 4.9 (P<0.0001), 3.013
to 4.166 (P<0.0001), and 4.3 to 4.625 (P =
0.101), respectively. Individually, 1 question from the hypertension session and 3
questions from the hyperlipidemia session reached significance. The cumulative patient feedback score was 4.744/5.
Conclusion: This study provides
evidence that student pharmacist–led
interactive sessions had a positive impact on health literacy. Patient feedback
supports the use of the open discussion
format as a valuable learning tool. Thus,
community outreach should be encouraged among student pharmacists and
pharmacists alike. More robust data collection is required to examine the full
benefit.
60—IMPLEMENTATION OF MEDICATION
ADHERENCE
SKILLS
TRAINING (GROUP MEDICATION
THERAPY MANAGEMENT) WITHIN A COLLABORATIVE FRAMEWORK OF SKILLS TRAINING FOR
AFRICAN AMERICAN BREAST
CANCER SURVIVORS: A RANDOMIZED CONTROLLED STUDY.
Rust C, South College School of Pharmacy, Brown L, Chapman University,
study were to: (1) evaluate the efficacy
of a medication adherence skills training alone compared with a medication
adherence skills training in conjunction
with a cancer skills psychoeducational
program in increasing medication adherence and self-efficacy; and (2) determine
the role of health literacy in medication
adherence and self-efficacy in African
American breast cancer survivors.
Methods: This pilot study utilized a
3-arm, randomized, repeated measures,
experimental design. The study sample
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consisted of an intervention group (n
= 23) of cancer survival skills training,
which included medication adherence
skills training, an intervention group (n
= 24) of medication adherence skill training only, and a control group (n = 24) for
a total study population of 71 participants. The Self-Efficacy for Appropriate
Medication Use Scale was used to measure patient confidence (self-efficacy) in
the ability to take medications properly.
The Adherence to Refills and Medications Scale measured patient adherence
to medications. The 3-question measure
for health literacy was used to assess level of health literacy.
Results: Results revealed that the
study could not confirm that cancer
skills training plus medication adherence training or medication adherence
skills training alone had a positive effect
on medication adherence or self-efficacy.
Even so, results support previous research that higher self-efficacy is associated with higher medication adherence.
Ad hoc testing of health literacy did not
show a statistically significant association between health literacy and medication adherence or self-efficacy.
Conclusion: Although there were no
significant findings with respect to medication adherence and self-efficacy, additional studies with larger sample sizes,
expanded eligibility criteria, and alternative measures of health literacy and
medication adherence are suggested.
61—IMPROVING
IMPLEMENTATION OF WRITTEN ASTHMA ACTION PLANS THROUGH PHARMACIST-DRIVEN INTERVENTION AT
THE POINT OF CARE IN A COMMUNITY SETTING. Adams S, Virginia Commonwealth University, Oliver
K, Jefferson Pharmacy, Moczygemba L,
Goode J, Virginia Commonwealth University, E-mail: [email protected]
of this study is to determine whether a
pharmacist-driven intervention at the
point of care will increase the percentage
of patients with asthma to have written
asthma action plans. This study also will
assess the knowledge and understanding of asthma for patients with action
plans compared with patients who do
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not have action plans, including comparison of demographics, medications, and
asthma control.
Methods: This prospective study
will be conducted at an independent
pharmacy in Palmyra, Virginia. Patients
≥18 years of age who self-report a diagnosis of asthma and have a prescription
for an albuterol inhaler will be selected
for inclusion in this study. The study
duration will be 12 weeks. All patients
picking up a new or refill prescription
for an albuterol inhaler will be flagged in
the pharmacy software system and approached at the pick-up counter. Patients
will self-select into the study by filling
out a brief survey assessing asthma history, knowledge about asthma, and status of a written asthma action plan. If
the patient does not have an action plan,
the pharmacist will provide education
about asthma action plans and offer to
complete a standardized action plan
with the patient. At the end of the study,
a comparison will be made between the
number of written asthma action plans
already in place at the beginning of the
study and the number of action plans developed by pharmacists. An assessment
will be made comparing knowledge and
understanding of asthma for patients
who self-reported having an asthma action plan at the time of survey completion to patients who denied having an
action plan. Comparisons also will be
made between these two groups to assess differences in age, race, highest education level completed, income, current
asthma medications, and asthma control.
62—PATIENT PERCEPTIONS AND
THE EFFECTS OF PROMOTING
THE USE OF A SINGLE COMMUNITY PHARMACY SYSTEM: A KEY
ELEMENT FOR IMPROVED TRANSITIONS OF CARE. Murthy L, Myftari
K, Kshatriya S, Dominick’s Pharmacy,
Winkler S, Harpe S, Midwestern University, Vatanka P, Safeway, E-mail: [email protected]
the study is to evaluate baseline patient
perception on the use of single versus
multiple community pharmacy systems.
The secondary objective is to determine
APhA2014 ABSTRACTS
the effects of a community pharmacist–
provided educational intervention on
the patient perception of using a single
community pharmacy system.
Methods: This will be a prospective
survey-based study implemented in a
single grocery store chain pharmacy site.
The primary investigator or designated
representative will administer an anonymous pre-survey to eligible patients who
drop off or pick up prescriptions during the study period. The pre-survey is
designed to collect demographic data
and determine subject perception on the
use of single versus multiple pharmacy
systems at baseline. The pharmacist will
then deliver a brief educational intervention, which will include the benefits
of using a single community pharmacy
system and the risks of using multiple
community pharmacy systems. The educational component will emphasize the
roles and responsibilities of community
pharmacists, medication safety both at
home and when transferring between
health care systems, and services offered
in the community pharmacy. An anonymous post-survey will be administered
after the educational intervention with
the pharmacist. The post-survey will be
used to determine whether a change in
the perception of the key components
assessed in the pre-survey has occurred.
Data will be analyzed utilizing descriptive statistics.
Results: Research in progress. It is
anticipated that a brief pharmacist intervention will increase patients’ awareness
on the benefits of using a single community pharmacy system. Using a single
community pharmacy system will increase accuracy on the medication record
and thus will position the community
pharmacist for a key role in improved
transitions of care.
63—PATIENT-REPORTED
PROBLEMS WITH USING GLAUCOMA
MEDICATIONS AND QUESTIONASKING
ABOUT
GLAUCOMA
MEDICATIONS DURING GLAUCOMA MEDICAL VISITS. Sayner R,
Blalock S, Carpenter D, University of
School of Pharmacy, Muir K, Duke University Medical Center, Hartnett M, Uni-
versity of Utah, Lawrence S, University
of North Carolina at Chapel Hill School
of Medicine, Robin A, Johns Hopkins
University, Sleath B, University of North
Carolina at Chapel Hill Eshelman School
of Pharmacy, E-mail: [email protected].
edu
Objective: This study examined the
extent to which patients who expressed
glaucoma medication problems asked 1
or more questions about those problems
during medical visits, the association
between sociodemographic characteristics and whether patients asked at least
1 question related to their reported problems, and the extent to which patients
reported the same medication problem 1
month after the medical visit.
Methods: This was a cross-sectional
study conducted at 6 ophthalmology
clinics. English-speaking adults with
glaucoma were recruited. Their medical
visits were videotaped. They were interviewed afterward. Patients returned
1 month later to be interviewed again.
Bivariate analyses were used to analyze
the data.
Results: In this analysis, there were
142 patients who expressed at least 1
glaucoma medication problem; 54% of
those who expressed problems with using their glaucoma medications asked
their physicians at least 1 question about
these problems during their examinations. African Americans were significantly less likely to ask at least 1 glaucoma medication question relating to
their reported problems compared with
non–African Americans (Pearson chisquare = 4.229, P = 0.040). Other patient
and provider characteristics were not
significantly associated with asking 1 or
more glaucoma medication questions
regarding their reported problem areas.
One hundred (70%) patients reported
the same glaucoma medication-related
problems 1 month later.
Conclusion: Approximately half of
the patients who reported at least 1 glaucoma medication-related problem asked
1 or more questions during their medical
visits. Many reported the same glaucoma medication problems 1 month later.
Pharmacists can help patients with glaucoma by offering to demonstrate how to
administer glaucoma medications and
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by answering any glaucoma medication
questions. Additionally, pharmacists
could work with the provider to resolve
any glaucoma medication issues. Finally,
pharmacists should encourage patients
with glaucoma to report to their doctor
any glaucoma medication problems that
they may be experiencing.
64—PATIENTS’ PERSPECTIVES ON
HEALTH CARE PROVIDERS’ MEDICATION COUNSELING. LaBuz M,
Cipollone D, Hartzell K, Hartzell’s Pharmacy, E-mail: [email protected]
is to evaluate patient perspectives on
best practice medication counseling provided by all health care providers.
Methods: Medications play a primary role in increasing patients’ life
expectancy and quality of life. Misunderstandings associated with prescribing decisions between practitioners and
patients have been reported due to lack
of participation of patients in the counseling session. This qualitative study will
utilize focus groups of patients who use a
community pharmacy to determine their
perspective on “best practice” medication counseling by health care providers.
Patients will be recruited through patient–pharmacy staff interactions at the
point of dispensing, phone interactions
based on lists developed in both pharmacy and home medical department, and
direct mailers. Patients will be provided
with a brief explanation of the research
project and questioned if they meet inclusion criteria. Inclusion criteria will
include but is not limited to ≥30 years of
age or a caregiver and ≥1 encounter with
a health care professional within the
year. A guided focus group question set
will be used. Sessions will continue until
saturation is reached and will be analyzed and coded using grounded theory
to elect theses. Themes of patient perceptions of medication counseling will
provide areas for focused improvements
and education for staff and patients.
65—USING VIDEOS TO IMPROVE
CHILDREN’S INHALER TECHNIQUE: A RANDOMIZED CONTROLLED TRIAL. Carpenter D, Geryk
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APhA2014 ABSTRACTS
L, Blalock S, University of North Carolina at Chapel Hill Eshelman School of
Pharmacy, Lee C, Polyglot Systems Inc.,
Weaver M, Reuland D, Coyne-Beasley T,
Loughlin C, University of North Carolina at Chapel Hill School of Medicine,
Sleath B, [email protected], Pharmaceutical Outcomes and Policy , Email: [email protected]
Objective: Prior research has shown
that most children with asthma have
suboptimal inhaler technique. This primary objective of this study was to determine whether a brief video intervention could improve inhaler technique in
children with asthma immediately after
a doctor’s office visit and 1 month later.
The study also evaluated whether the
intervention led to better inhaler selfefficacy and asthma control at 1-month
follow-up.
Methods: Ninety-nine children aged
7 to 17 years with persistent asthma were
recruited at 2 nonurban pediatric practices in North Carolina. Eligible children
demonstrated their inhaler technique
for metered-dose inhalers (MDIs) either with or without a spacer. A trained
research assistant used a validated inhaler technique checklist to record which
steps children performed correctly.
After a regularly scheduled office visit,
children were randomized to watch either a 3-minute MDI video (intervention group) or a nutrition video (control
group) in English or Spanish. Children’s
technique was assessed again after
watching the video and 1 month later.
Results: Children were primarily
male (56%) and non-white (60%). Children in the intervention group demonstrated a significant improvement in
MDI technique immediately post-intervention (mean = 1.12, 95% confidence
interval [CI] 0.73–1.50) and at 1-month
follow-up (mean = 0.87, 95% CI (0.47–
1.26); however, the between-group difference was only significant post-intervention (mean = 1.08, 95% CI 0.53–1.63).
At 1-month follow-up, the intervention
group reported higher inhaler self-efficacy (mean 0.28, 95% CI 0.01–0.55) and
asthma control (mean = 1.93, 95% CI
0.71–3.16); however, the between-group
differences were not significant.
Conclusion: A brief video interven-
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tion offered during pediatric clinic visits
can improve children’s inhaler technique. Future research should evaluate
whether it is feasible to offer the intervention in a pharmacy setting and determine whether booster training is necessary to yield long-term improvements in
inhaler technique.
Diabetes
66—ASSESSMENT OF A COMMUNITY PHARMACY–BASED EDUCATION PROGRAM AND PHARMACIST INTERVENTION TO OPTIMIZE INSULIN DELIVERY. Ahmed
L, Kshatriya S, Dominick’s Pharmacy,
Goliak K, University of Illinois at Chicago, Shah A, Dominick’s Pharmacy,
Vatanka P, Safeway Inc., Touchette D,
University of Illinois at Chicago, E-mail:
[email protected]
this study is to determine the number
and type of interventions identified by
pharmacists and assess patient satisfaction with their insulin delivery experience following a pharmacist-conducted
insulin delivery education program. The
secondary objective is to evaluate the effectiveness of the Insulin Administration
Assessment Tool (I-AAT) in identifying
patients who would benefit from pharmacist education and/or intervention.
Methods: This is a prospective, survey-based, multi-site study evaluating
the development and implementation of
an insulin delivery education program
in the community pharmacy setting.
Adults ≥18 years of age using any type
of insulin will be recruited for this study.
Exclusion criteria include patients using
an insulin pump, GLP-1 agonists, amylin
analogs, and those who have not filled
their insulin since January 1, 2013. At
the time of enrollment, participants will
sign a consent form and complete the IAAT. This tool will assess each participant’s confidence with administration
technique, level of discomfort, adverse
reactions, adherence, and affordability
of their current insulin device. Each participant will attend a one-on-one education session with a pharmacist, who will
show an educational video on proper
injection technique, demonstrate how
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to use the insulin device, and allow participants to practice injecting themselves
using various size needles or devices.
Pharmacists will intervene, as needed,
to optimize each patient’s insulin delivery experience. The number and type of
interventions will be documented using
an insulin delivery intervention record.
A short survey, evaluating the same factors as the I-AAT, will be administered
4 weeks after pharmacist education to
determine the impact on patient satisfaction with their insulin delivery experience.
number and type of interventions will
be presented and compared with I-AAT
scores. Responses to I-AAT and the telephone survey will be analyzed.
67—ASSESSMENT OF SELF-CARE
ADHERENCE IN PATIENTS WITH
DIABETES. Brocious B, Virginia Commonwealth University, Grimes M, Buford Road Pharmacy, Oliver K, Jefferson
Pharmacy, Moczygemba L, Goode J,
Virginia Commonwealth University, Email: [email protected]
study are to: (1) evaluate diabetic patients’ adherence with their self-care
measures; and (2) design a pharmacybased intervention program to improve
adherence to self-care measures for patients with diabetes.
Methods: A prospective, descriptive study of approximately 150 participants will be conducted over 3 months
at 2 independent pharmacies located in
Richmond and Palmyra, Virginia. Participants are eligible for the study if they
are ≥18 years of age and are receiving
medication to treat diabetes. Participants
in the study will complete a survey consisting of questions about their adherence to evidence-based diabetes self-care
recommendations, including adherence
with immunizations, diet, exercise, eye
and dental exams, and medications. The
survey was adapted from the Summary
of Diabetes Self-Care Activities. Patient
demographics will be collected and
summarized, including sex, age, race,
education level, annual income, type of
diabetes, time since diabetes diagnosis,
whether the patient is being followed
APhA2014 ABSTRACTS
by an endocrinologist/specialist, and
whether the patient has ever been counseled by a pharmacist or physician on
self-care needs. Results will be calculated
comparing the percentage of patients
who are adherent to their self-care with
those who are not adherent. Results will
be used to develop a pharmacy-based
intervention program for patients with
diabetes.
68—CLINICAL OUTCOMES OF
SWITCHING
FROM
INSULIN
GLARGINE TO NPH INSULIN IN
INDIGENT PATIENTS AT A CHARITABLE PHARMACY: THE CINCI
STUDY. Curington R, University of
Cincinnati, E-mail: russell.curington@
uc.edu
study is to assess the clinical outcomes
(i.e., changes in A1C; 30-day average,
high, and low blood glucose; number of
hypoglycemic episodes; and Morisky
Medication Adherence Scale [MMAS]
scores) following a therapy change from
insulin glargine to an NPH-based insulin
regimen in indigent patients with diabetes type 2 at a charitable pharmacy.
Methods: Subjects who qualify for
charitable prescription services at St.
Vincent de Paul Charitable Pharmacy
through a financial verification process
to prove low income are enrolled in
this prospective cohort pilot study for
24 weeks following an insulin therapy
change from insulin glargine to NPH insulin. Current patients of the pharmacy
with diabetes type 2, an established
health care provider, English-speaking,
>18 years old, and a history of using insulin glargine within 3 months prior to enrollment are enrolled in the experimental
group of this study. Subjects using an
NPH-based insulin regimen for diabetes
control >3 months and meeting eligibility requirements are enrolled in the control group of this study. Blood glucose
and signs/symptoms of hypoglycemia/
hyperglycemia are reported weekly for
4 weeks following enrollment. Clinical
outcomes of A1C, blood glucose, signs/
symptoms and frequency of hypoglycemia/hyperglycemia, 30-day low, 30-day
high, and 30-day average are reported
at baseline, 3 months, and 6 months after enrollment. Outcome variables (i.e.,
changes in A1C; 30-day average, high,
and low blood glucose; number of hypoglycemic episodes; and MMAS scores)
are compared at baseline and follow-up
appointments at 1 month, 3 months, and
6 months. Safety is assessed by reports of
hypoglycemia, effectiveness is assessed
by changes in A1C and blood glucose
readings, and changes in compliance are
assessed by MMAS scores. Confidence
intervals are used to assess whether the
intervention is non-inferior to the control. P values are used to determine statistical significance. Baseline data are reported as means and standard deviation
for continuous data and numbers and
percentages for categorical data.
Results: Research in progress. Subjects in both control and experimental
groups will be followed for the duration of this study. Data will be collected
through study completion and analyzed
to determine whether the intervention
displays non-inferiority to the control.
69—DIABETES AND IMMUNIZATIONS: UNDERSTANDING THE
GAP IN PREVENTIVE CARE. Frease
A, Butler M, Mercer University College
of Pharmacy, Carmon M, Rite Aid Pharmacy, E-mail: [email protected]
study are to: (1) describe diabetic patients and health care providers throughout the local area with regard to their
views and knowledge of diabetic immunization guidelines; (2) provide information on the role of the pharmacists
in educating and immunizing diabetic
patients; and (3) identify correlations in
knowledge and viewpoints of patients
with respect to demographic factors.
Methods: Two survey instruments
will be utilized to assess diabetic patients
and their health care team. The patient
survey will evaluate their understanding
of vaccine recommendations and their
reason for making decisions to receive
vaccinations. The health care providers
and their team (i.e., internal medicine
physicians, medical assistants, nurses,
pediatricians, pharmacists, and physician assistants) will be surveyed regarding their knowledge of diabetic-specific
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vaccine guidelines and patient adherence to recommended vaccines. Patients
who are currently enrolled in a diabetes
education program will be excluded
from the survey. New patients will be
able to participate in the survey.
study has received institutional review
board approval, and data collection will
begin October 2013. Data will be analyzed appropriately to report findings.
The results of the patient survey will be
used to better understand diabetic patients’ resistance and knowledge on appropriate immunization therapy. The
results of the health care provider survey
will be used to determine provider understanding of diabetic-specific guidelines and their perception on the role of
pharmacists in administering immunizations.
70—DURATION OF DISEASE AND
PREVIOUS EDUCATION AS INDICATORS OF DEGREE OF KNOWLEDGE: A SURVEY OF PATIENTS
WITH DIABETES. Atchley D, University of Tennessee/Kroger, Crain J, Marchetti M, Kroger, Bess D, University of
Tennessee College of Pharmacy, E-mail:
[email protected]
this study is to explore the relationship
between duration of diabetes diagnosis,
level of previous diabetes education, and
level of diabetes knowledge in a diverse
population to help identify and further
understand gaps in diabetes care and
education. Based on how long a patient
has been assigned a particular diagnosis, health care providers may assume
patients are knowledgeable and welleducated regarding that chronic disease
state. For this reason, patients may be
overlooked for interventions and targeted education opportunities.
Methods: Patients will be identified
at the pharmacy during the prescription filling process. All patients aged ≥18
picking up an antihyperglycemic medication will be eligible to take a diabetes
knowledge assessment. The surveys will
be distributed in 7 Kroger pharmacies located in Robertson, Sumner, and northern Davidson counties in Tennessee. The
questionnaire will be distributed by the
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APhA2014 ABSTRACTS
pharmacy resident or other pharmacy
staff. Once collected, data will be compiled and analyzed using appropriate
statistical methods to determine the correlation between duration of diabetes diagnosis, level of previous diabetes education, and level of diabetes knowledge.
71—AN EVALUATION OF A PHARMACIST’S IMPACT ON PHYSICIAN ADHERENCE TO CLINICAL
PRACTICE GUIDELINES FOR THE
TREATMENT OF HYPERTENSION
IN PATIENTS WITH DIABETES. McConaha J, Tedesco G, Duquesne University, E-mail: [email protected]
Objective: Current American Diabetes Association guidelines recommend
that the treatment of hypertension in
patients with diabetes should include an
angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) medication. Despite these recommendations, studies have shown that
only approximately half of patients with
diabetes are currently being treated with
an ACEI or an ARB. This study utilized a
pharmacist embedded within a primary
care physician (PCP) practice to perform
electronic chart reviews and document
the effect that the pharmacist’s recommendations had on improving physician
adherence with these guidelines.
Methods: Patients whose chart contained an International Classification
of Diseases–9th revision (ICD-9) diagnosis code 250 (diabetes mellitus type
2), ICD-9 diagnosis code 401 (hypertension), and were not already on an ACEI
or ARB medication were identified in the
electronic medical record (EMR) via an
established search function. The pharmacist, with the help of student pharmacists, then reviewed these charts to
establish whether the patient would be a
candidate for therapy. Exclusion criteria
included: drug allergy, other compelling
indications for alternative antihypertensive therapy, hyperkalemia, blood
pressure controlled without medication,
and age >75 years. If a patient met the
criteria, a standard electronic communication was sent to the patient’s PCP via
the EMR explaining the purpose of the
review and any relevant findings.
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Results: Of the initial patients identified (N = 954), a total of 169 patients
were believed to be eligible for therapy
and recommendations were sent. Of
the 143 responses received, 78 were acceptance of the recommendation (54.5%
acceptance). A total of 42 patients went
on to receive therapy, 9 patients did not
subsequently receive therapy, and 27
patients needed to schedule follow-up
before therapy could be initiated.
Conclusion: Pharmacists and student pharmacists can provide an important service in ensuring physician compliance with clinical practice guidelines.
Access to the EMR can facilitate this process and improve physician acceptance
rates.
72—IMPACT OF AMBULATORY
CARE PHARMACY SERVICES IN A
PRIVATE PHYSICIAN’S PRACTICE
ON PATIENTS WITH DIABETES.
Murphy B, Byrd J, Kuhl D, Midha S,
Union University School of Pharmacy,
Objective: This study evaluates the
impact of newly implemented ambulatory care pharmacy services on surrogate disease markers in diabetic patients
treated in a private physician’s practice.
Methods: Under institutional review board approval, retrospective and
concurrent electronic medical record
review was conducted of diabetic patients receiving care at an outpatient
clinic managed by private family practice and internal medicine providers.
Ambulatory care pharmacy services
were implemented in January 2012 at
the clinic, located within a small city in
a predominantly rural area. Services
consist of a comprehensive diabetes education program combined with medication therapy adjustments as required in
collaboration with the providers. Baseline data were obtained for all referred
patients. Follow-up data were collected
from January 1 through December 31,
2012. Data collection included: patient’s
age, weight, body mass index (BMI), systolic and diastolic blood pressure, A1C,
low-density lipoprotein (LDL), triglyceride, total cholesterol, and high-density
lipoprotein (HDL). A paired t test was
used to compare variables at baseline
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versus follow-up. Attainment of clinical
marker goals at baseline and follow-up
was compared using chi-square or Fisher’s exact test, as appropriate. alpha was
set a priori at 0.05.
Results: Baseline data were collected in 86 patients. A1C values significantly decreased by 1.3 ± 2.1% (P = 0.0003)
with significantly more patients being at
goal A1C (25.3% vs. 60.0%, P = 0.0002).
Patients lost an average of 4.472 lb (P =
0.0002). Statistically significant improvements also were seen in LDL (–10.758
mg/dL, P = 0.042), HDL (+2.879 mg/dL,
P = 0.0239), triglyceride (–37.758 mg/dL,
P = 0.017), and total cholesterol (–16.061
mg/dL, P = 0.0059) levels. Changes seen
in systolic and diastolic blood pressure,
as well as BMI, were not statistically significant.
Conclusion: Despite a relatively
short follow-up, pharmacist involvement in an outpatient, private practice
significantly improves most established
objective surrogate markers associated
with diabetes management. Longer follow-up is ongoing to further assess this
impact.
73—IMPACT OF PHARMACIST INTERVENTION ON A1C IMPROVEMENTS IN A COMMUNITY PHARMACY SETTING. Turner J, Southwestern Oklahoma State University College
of Pharmacy/Walgreens, Williams N,
Southwestern Oklahoma State University College of Pharmacy, Kinnard J, Walgreens, E-mail: [email protected]
Objective: The purpose of this project is to determine whether pharmacistprovided education and coaching in a
community pharmacy setting can help
low-income patients with poorly controlled diabetes improve their A1C. Diabetes affects over 25 million adults in the
United States, with the majority of the
population diagnosed with type 2 diabetes. Glycemic control has been shown
to minimize complications. Patients with
low income may pose a greater challenge
in maintaining their diabetes control. Because pharmacists are easily accessible
health care providers, they may be able
to impact diabetes care.
Methods: Adult patients ≥18 years
of age presenting to the community
APhA2014 ABSTRACTS
pharmacy with type 2 diabetes on >1 oral
diabetic medication, or on an oral medication and insulin or other injectable
medication, will be contacted to enroll in
the study. These patients will be identified through a medication report, as well
as upon presentation of prescriptions
that meet study criteria. Study duration
will occur during a 6-month period from
November 2013 through May 2014. Exclusion criteria will include patients <18
years of age. Data collection will include
A1C and body composition taken at initial visit and at 3- and 6-month intervals.
Patient demographic information and income level also will be collected at initial
visit. Patients will receive standardized
pharmacist counseling about their diabetes medications and lifestyle changes
during these visits. Approximately 45
days after their initial and 3-month A1C
measurements, patients will be contacted via telephone to assist with lifestyle
changes and medication understanding
and adherence, and address any questions or concerns. This study will be approved by the university institutional
review board, and informed consent will
be obtained for all patients enrolled in
the study. To maintain patient confidentiality, all data will be de-identified.
74—IMPACT OF PHARMACIST INTERVENTION ON DIABETES CARE
AT A FEDERALLY QUALIFIED
HEALTH CENTER. Jackson A, Sullivan
[email protected]
Objective: This study aims to assess
the impact of pharmacist intervention
on diabetes-related outcomes compared
with those of patients receiving usual
care.
Methods: Pharmacists provided
comprehensive clinical services for patients with uncontrolled diabetes at a
federally qualified health center through
a diabetes management program. Patients with A1C >9% were enrolled in
the program by physician referral. Upon
enrollment in the program, patients were
eligible to receive free diabetic testing
supplies. Patients included in the study
were ≥18 years of age with type 2 diabetes who had completed >2 clinic visits.
Pharmacists provided patient education, clinical assessment, drug therapy
management, and follow-up care. Intervention patients were compared
with patients having similar baseline
demographics receiving diabetes care
solely from their primary care provider.
Primary outcomes include changes in
A1C from baseline and achievement of
treatment goals. Secondary parameters
include changes in baseline lipid levels,
blood pressure, and body mass index.
Data will be derived from retrospective
chart reviews of selected patients. Data
will then be evaluated using descriptive
statistics.
75—IMPACT OF A POSTGRADUATE
YEAR 1 COMMUNITY PHARMACY
RESIDENCY ON TYPE 2 DIABETES
OUTCOMES IN A PRIMARY CARE
PRACTICE. Toale A, University of
North Texas System College of Pharmacy, Giaccotto M, O’Connor K, University
at Buffalo School of Pharmacy and Pharmaceutical Sciences, Perna A, Internal
Medicine Practice, Monte S, Brody Jr. P,
University at Buffalo School of Pharmacy
and Pharmaceutical Sciences, E-mail: [email protected]
this study was to determine the change in
A1C from baseline to 3, 6, and 12 months
in type 2 diabetics seen by a postgraduate year 1 (PGY1) community pharmacy
resident within a primary care private
physician practice. Secondary objectives
were to assess changes in prescribing
practices, blood pressure, cholesterol,
body mass index (BMI), fasting glucose,
and hepatic and renal function.
Methods: The PGY1 community
pharmacy resident met independently
with patients referred by the physician
or nurse practitioners from January
2011 through December 2012 (n = 129)
to provide ongoing disease state and
medication education, self-management
techniques, and diet and exercise counseling. The resident made medication
recommendations to the providers based
on patients’ medical and social history,
laboratory and at-home glucose levels,
and subjective patient data. Data were
collected retrospectively at baseline (first
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appointment with resident), 3, 6, and 12
months and statistical analysis was conducted using Student t test and descriptive statistics with significance defined as
P<0.05.
Results: Patients’ A1C decreased
from 8.4 ± 2.1% at baseline to 7.2 ±
1.3% (P<0.001) at 3 months, 7.4 ± 1.9%
(P = 0.002) at 6 months, and 7.4 ± 1.5%
(P<0.001) at 12 months. Prescribing practices at 12 months revealed a decrease
in sulfonylurea use by 15.1% (26.5 vs.
11.4%), increase in incretin mimetic use
by 32.7% (12.7 vs. 45.5%), increase in basal insulin use by 27.7% (38.2 vs. 65.9%),
and increase in statin use by 11.9% (67.6
vs. 79.5%). Significant changes in BMI
were observed at 6 months (34.5 ± 7.9
kg/m2 vs. 32.4 ± 6.89 kg/m2, P = 0.005).
Significant changes in low-density lipoprotein were seen at 12 months (96 ± 34
mg/dL vs. 81 ± 31 mg/dL, P = 0.034).
Conclusion: This study demonstrates improvement in clinical outcomes
of patients referred to the PGY1 community pharmacy resident for diabetes
management. Integrating community
pharmacy residents into primary care
providers’ practices provides improved
patient care, value to the practice, and
training experience for the resident.
76—IMPLEMENTATION OF AN
INSULIN PROTOCOL TO REDUCE
HYPOGLYCEMIC EVENTS AND
IMPROVE SAFETY. Bittner A, Hertig J,
Purdue University College of Pharmacy,
study is to evaluate the efficacy of an insulin protocol used in an ambulatory setting to reduce the rate of hypoglycemic
events in patients with diabetes mellitus.
Methods: The study protocol was
submitted to the institutional review
board in October 2013; data collection
will commence with approval. A community pharmacy–based diabetes center
has established a collaborative practice
insulin management protocol with primary care physicians and endocrinologists in the southern Indiana region. A
pharmacist implements the protocol
on an individual referral basis. Insulin
dose adjustments are made according
to the patient’s self-monitoring of blood
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APhA2014 ABSTRACTS
glucose (SMBG) results. The study will
compare the total number of hypoglycemic events in patients on the protocol
to insulin-dependent patients not on
protocol. Additionally, the total percent
of time each patient was hypoglycemic
will be calculated. Retrospective data
collection will include a sample size of
100 to 150 patients from October 1, 2008
through October 1, 2013. Parametric or
nonparametric statistics will be used as
appropriate to analyze SMBG data.
77—INTERPROFESSIONAL
COMMUNITY-BASED DIABETES
SCREENINGS AS A RECRUITMENT
MEDIUM FOR PATIENT ENROLLMENT INTO STUDENT PHARMACIST–FACILITATED
DIABETES
EDUCATION. Liu R, Jung E, Creighton University School of Pharmacy and
Health Professions, E-mail: RogerLiu@
creighton.edu
Objective: The goal of this study was
to determine whether community diabetes screenings were effective for recruiting patients to attend group diabetes
education sessions. The study also aimed
to determine whether patients receiving
abnormal results at a community screening received follow-up care from their
health care provider.
Methods: Free health screenings
were provided to community residents
at 7 community pharmacies by 72 pharmacy and 13 physical therapy students.
After each screening, students offered
diabetes education counseling and encouraged participants to follow up and/
or share their screening results with their
health care provider. Additionally, all
high-risk participants could provide
their contact information in preparation
for enrollment into the study. Participants were considered high risk with a
fasting blood glucose >100 mg/dL or
non-fasting blood glucose >200 mg/dL.
One month after screenings concluded,
participants who provided contact information were invited to attend a free,
student pharmacist–run, group diabetes
education session utilizing U.S. Diabetes Conversation Maps. Study enrollees
who did not attend were considered lost
to follow-up.
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Results: Of 244 participants
screened, 38 (15.57%) were identified
as high risk. Of the 38 high-risk participants, 17 (44.74%) provided contact information and were offered enrollment
into the study. All 17 participants asked
to join the group diabetes education sessions were ultimately lost to follow-up.
Of the 17 participants, 8 (47.06%) did
not respond to contact attempts. Of the
9 participants (52.94%) who responded,
4 (44.44%) followed up and/or shared
their screening results with their health
care provider. High-risk participants
who did not consent to study enrollment
were encouraged to do so as well.
Conclusion:
Community-based
diabetes screenings are not an effective
recruitment medium for participant enrollment into additional diabetes education sessions. However, these screenings
may be useful in identifying high-risk
patients and recommending those patients to follow up with their health care
provider.
Q 78—LONG-TERM RETROSPECTIVE
CASE-CONTROL
STUDY
COMPARING TWICE DAILY INSULIN GLARGINE TO TWICE DAILY
INSULIN DETEMIR IN PATIENTS
WITH TYPE 2 DIABETES AT A VETERANS ADMINISTRATION MEDICAL CENTER. Harmon T, Worrall T,
Ralph H. Johnson Veterans Affairs Medical Center, E-mail: thomas.worrall@
va.gov
is to determine the efficacy and tolerability of insulin glargine and insulin
detemir administered twice daily over a
12-month period in veterans with type 2
diabetes and an A1C ≤9%.
Methods: A retrospective case-control study of patients prescribed either
twice daily insulin detemir or glargine
was conducted. The insulin detemir
and glargine groups were matched on
age, baseline A1C, and daily basal insulin dose. The primary aim was to determine whether there was a difference in
A1C between the groups at time 0 and 12
months. The secondary aim was to determine whether there was a difference in
the daily dose of basal insulin between
the groups at time 0 and at 12 months.
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A descriptive analysis of the patients
requiring a change in basal insulin was
completed. The mean difference in treatment cost was evaluated at 12 months.
Results: Baseline characteristics
were similar. The median A1C at 12
months was 8.3 and 8.7 in the insulin detemir and glargine groups, respectively
(P = 0.73), with no difference in the insulin detemir group and a 0.3% increase in
the insulin glargine group. The median
daily basal insulin use was 0.93 units/kg
and 0.95 units/kg in the insulin detemir
and glargine groups, respectively (P =
0.8), with a difference of +0.3 units/kg
and +0.5 units/kg in the insulin detemir
and glargine groups. There was an estimated cost savings of $266.30 per patient
in the insulin detemir group.
Conclusion: Glycemic control in
this study did not differ from previously
published studies that compared insulin
detemir and glargine. Of note, this study
did show a daily dose of insulin detemir
that was less than insulin glargine, but
the results were not statistically significant. There was not a difference in efficacy or tolerability between the insulin
detemir and glargine groups when administered twice daily.
Original
Citation:
Retrospective Case-Control Study Comparing
Twice-Daily Insulin Glargine and Insulin Detemir in Veteran Patients with
Type 2 Diabetes. Timothy Harmon,
Pharm.D., Thomas J. Worrall, Pharm.D.,
BS(Pharm); Ralph H. Johnson VAMC,
Charleston, SC.
79—PROJECT IMPACT DIABETES:
MAKING HEALTHY CONNECTIONS IN A U.S.–MEXICO BORDER
Sias J, University of Texas at El Paso,
Castrellon J, Lucero A, Kelly J, Centro
de Salud Familiar La Fe Inc., Morton K,
Southwest CARE Center, E-mail: jjsias@
utep.edu
study are to: (1) create healthy connections for patients with diabetes using an
interdisciplinary approach for a predominantly Spanish-speaking population
served by a community health center
(CHC) on the U.S.–Mexico border; and
(2) document clinical changes and con-
APhA2014 ABSTRACTS
nections to health services made to improve care for these patients.
Methods: The pharmacy leadership created an interdisciplinary team
representing dental, health education,
medical, nursing, pharmacy, and social
work departments. During monthly
meetings, the team took steps to improve
clinical outcomes and health behavior
interventions for patients with diabetes
in a culturally and linguistically appropriate manner. The team developed an
inter-department referral system with
specific efforts to increase clinical pharmacy appointments and participation in
health education classes as well as other
CHC services. To capture missing A1C
values, the pharmacy implemented use
of an A1C point-of-care (POC) device at
the counseling window. Further, pharmacists worked with health educators
to design grocery store tours for patients
with a limited budget. Patients were able
to plan, shop for, and prepare $5 healthy
meals for a family of 4 people.
Results: The interdisciplinary team
enhanced their internal referral system
for primarily Spanish-speaking patients
with diabetes. Sixty participants (with
informed consent) showed an average
A1C decrease of –1.4% (9.6% to 8.2%, P
= 0.000) over 11 months. The community
pharmacy began billing for A1C POC
measurements. Through this interdisciplinary effort, patients connected to
health classes and interventions related
to diabetes. Twelve patients participated
in six 4-hour grocery store tours. Over
600 encounters among recruited participants occurred across pharmacy, health
education, dental, social, and immunization services.
Conclusion: The interdisciplinary
team improved clinical markers while
making new healthy connections for patients served by this border CHC. Other
clinics and community pharmacies may
benefit from this model to improve diabetes management by strengthening interdisciplinary teams, improving referral
systems, and encouraging multiple connections with patients.
80—PROJECT IMPACT DIABETES:
OUTCOMES OF DIABETES AWARENESS TO REACH EXCELLENCE—
MAKING A DIFFERENCE IN THE
HOMELESS. Stevens L, The Daily Planet, Goode J, Gatewood S, Moczygemba
L, Virginia Commonwealth University,
study are to: (1) develop an innovative
interprofessional diabetes program in
a patient-centered medical home (PCMH) for the homeless or those at risk for
homelessness; and (2) evaluate the impact of Diabetes Awareness to Reach Excellence (DARE) on clinical and preventive diabetes health-related outcomes.
Methods: DARE–Making a Difference in the Homeless was implemented
in September 2011 in a federally qualified
health center for the Homeless Clinic.
Patients were enrolled in the program
if they had an A1C >7.0. A weekly diabetes day was created, which included
group education and joint patient appointments with the physician and pharmacist. Patients participated as often as
necessary and could attend the group
sessions without an appointment. The
interprofessional program includes a
physician, pharmacist, nurse, dietitian,
health educator, optometrist, and case
manager. The team worked with patients to help overcome barriers associated with diabetes care and homelessness.
Patients were helped with payment for
medications (if needed), testing supplies,
and bus passes, and they received special
incentives such as healthful snacks during group classes. Outcome measures
evaluated were A1C, body mass index
(BMI), blood pressure (BP), lipid panel,
foot exams, eye exams, smoking status,
and influenza vaccine.
Results: Sixty-four patients participated in the program for 12 months;
there was an average of 9 visits per
patient. Mean age was 52.8 years and
73.4% were men. Mean A1C decreased
0.5% (P = 0.049), while mean baseline
BP started at goal and remained stable.
BMI increased slightly from 31.8 to 32 (P
= 0.0195). Baseline total cholesterol, highdensity lipoprotein cholesterol, and lowdensity lipoprotein cholesterol started
at goal with triglycerides significantly
decreasing from 183.5 to 147.2 (P = 0.012).
Smoking status decreased from 48.3% to
46.8%, eye exam status increased from
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7% to 14%, foot exams increased from
95% to 96.7%, and no significant change
in influenza vaccines.
Conclusion: An interprofessional
diabetes program can help patients who
are homeless or those at risk for homelessness maintain and improve clinical
and preventive diabetes health-related
outcomes.
Q 81—PROJECT IMPACT DIABETES: PATIENT SELF-MANAGEMENT KNOWLEDGE OF DIABETES
AFTER PARTICIPATION IN DIABETES AWARENESS TO REACH EXCELLENCE—MAKING A DIFFERENCE IN THE HOMELESS. Goode J,
Virginia Commonwealth University,
Stevens L, The Daily Planet, Gatewood
S, Moczygemba L, Virginia Commonwealth University, E-mail: jrgoode@vcu.
edu
is to evaluate the impact of Diabetes
Awareness to Reach Excellence (DARE)
on diabetes patient self-management
knowledge.
Methods: DARE–Making a Difference in the Homeless is an interprofessional diabetes education and management program within a patient-centered
medical home. It was implemented in
September 2011 at a federally qualified
health center for the homeless persons.
Homeless persons or those persons at
risk for homelessness with diabetes
mellitus and who have an A1C >7 were
enrolled in DARE. The American Pharmacists Association Foundation’s Patient Knowledge Assessment was used
to assess diabetes knowledge. Patients
completed a baseline diabetes self-management knowledge assessment and
completed the same assessment 1 year
after participation in the program. Selfmanagement knowledge scores were
categorized as beginner, proficient, and
advanced. The raw scores and proficiency assessment were evaluated.
Results: Forty-two patients completed both the baseline and final knowledge assessment. Mean score increased
to 26.62 from a baseline of 23.55. Selfmanagement proficiency at baseline: beginner 50%, proficient 42.9%, advanced
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ment proficiency improved: beginner
19%, proficient 66.7%, and advanced
14.3%.
Conclusion: An interprofessional
diabetes education and management
program can improve diabetes self-management knowledge in patients who are
homeless or at risk for homelessness.
Original Citation: ADA Disparities
Conference 2013
Educating the Educators
82—ASSESSING THE IMPACT OF
PHARMACIST-PROVIDED
FITNESS, NUTRITION, AND WEIGHT
MANAGEMENT
COACHING
CLASSES ON BIOMETRIC OUTCOMES. Huffman K, Bourg C, Young
H, University of Georgia, Grubbs K,
Kroger Pharmacy, E-mail: ket986@
gmail.com
study is to examine the impact of community pharmacist–led coaching program on patient biometric outcomes.
Methods: A retrospective chart review of patients who have completed a
pharmacist-led coaching program will
be conducted. The program consists of
13 visits and focuses on fitness, nutrition, and weight management. Data will
be obtained from 35 patient care centers
across 4 states. Outcomes collected include the following biometric markers:
blood pressure, body mass index, cholesterol, and weight. Bivariate and multivariate analyses will be conducted to
examine pre- and post-program differences in biometric outcomes.
anticipated result from this research
is that the majority of patients benefit
from the program, which would be supported by the improvement in biometric
markers from baseline to post-program.
Obesity is a prevalent condition associated with greater morbidity. Findings
from this study may encourage the use
of community pharmacist programs to
help improve patients’ fitness, nutrition,
and weight management which in turn
would reduce cost for third-party payers. Pharmacists who provide coaching
undergo specific training to become a patient care specialist with the pharmacy.
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This study holds significance for patients
due to increased access to nutritional resources and services in the community.
In addition, the implementation of such
programs may benefit society by helping
to reduce the problem of obesity and associated negative outcomes.
83—EVALUATING PROFESSIONAL
ENGAGEMENT:
DEVELOPMENT
AND PILOT TESTING OF THE
STUDENT PHARMACIST INVENTORY OF PROFESSIONAL ENGAGEMENT. Aronson B, Smith R, University
of Minnesota, E-mail: [email protected].
edu
Objective: The aim of this study is
to describe the development and initial
psychometric testing of a novel instrument, the Student Pharmacist Inventory
of Professional Engagement (S-PIPE), to
assess professional engagement.
Methods: A 21-item instrument was
developed from prior qualitative work
that gathered students’ perceptions of
professional engagement. A paper survey was offered to all third-year student
pharmacists at a college of pharmacy.
Exploratory factor analysis was performed using a principal component
analysis (PCA) extraction. One item with
low item-item correlation (<0.3) was removed after the initial extraction. After
subsequent extraction with oblimin rotation, 1 item with weak loadings (<0.3)
on all factors was removed. Another
PCA extraction with oblimin rotation
was performed. Three items with strong
loadings (>0.4) on multiple factors were
evaluated and placed in the best fitting
conceptual factor. The internal consistency of the items within each factor was
evaluated using Cronbach alpha.
Results: A 5-factor solution emerged
based upon eigenvalues >1, describing
70.34% of the variance in the data. The
Kaiser-Meyer-Olkin value was 0.849,
demonstrating “meritorious” sampling
adequacy. Bartlett’s test of sphericity was
significant (P<0.001), indicating the data
were factorable. Factors were named
based upon the content of the items that
comprised the factors. The 5 factors and
their internal reliabilities are: belonging
(alpha = 0.878, 6 items); professional impact (alpha = 0.750, 3 items); prepared for
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profession (alpha = 0.917, 2 items); educational impact (alpha = 0.788, 4 items);
and growth (alpha = 0.745, 4 items).
Conclusion: Professional engagement is an attribute vital to the professional membership of pharmacy. This
research describes the development of a
novel instrument to assess professional
engagement in student pharmacists.
The S-PIPE is composed of 5 factors with
high internal reliability. Future research
will involve expanding the question
bank to cover all factors of professional
engagement, and assessing validity and
reliability of the complete instrument.
84—EVALUATION OF THE RETURN
ON INVESTMENT OF A COMMUNITY PHARMACY RESIDENT IN
AN INDEPENDENT PHARMACY
IN RURAL MISSISSIPPI. Brown M,
Warrington L, Cannon E, Latendresse E,
Ross L, Bloodworth L, University of Mississippi School of Pharmacy, Mosby W,
Mosby’s Drugstore, E-mail: mminor@
umc.edu
study is to evaluate the return on investment of integrating a community pharmacy resident into an independent community pharmacy. Community pharmacies are one of the most accessible health
care settings. They also serve as a rich
environment for student pharmacists
and residents to participate in establishing and expanding pharmacy services
to improve patients’ medication use and
quality of care. The purpose of this study
is to evaluate the impact of service implementation and enhancement in an independent community pharmacy in rural
Mississippi, serving as a new residency
preceptor site with limited existing clinical services.
Methods: This study is institutional
review board approved. It is a prospective evaluation of primary and secondary economic outcomes related to new
service implementation over a 1-year
period. A community pharmacy resident provides services 1 day each week
in the pharmacy. Services evaluated in
this study include medication therapy
management (MTM) visits, point-of-care
(POC) screenings, and immunization
programs. The primary outcome is to
APhA2014 ABSTRACTS
evaluate the cost-to-benefit ratio for the
pharmacy with the implementation and
enhancement of services. The financial
impact of MTM services will be evaluated using an online MTM billing system.
Secondary outcomes include number of
patients receiving immunizations, type
of immunization administered, number
of MTM visits, number of POC screenings, and impact on prescription volume.
preceptor and resident began providing
services in September 2013. To date, the
following have been completed: 4 MTM
visits; 9 blood glucose POC screenings;
and 38 influenza, 6 pneumococcal, and 4
herpes zoster vaccinations.
85—IMPACT OF DELIVERING TOBACCO-PREVENTION PRESENTATIONS ON STUDENT PHARMACISTS. Prudencio J, Batz F, Savona N,
University of Hawaii at Hilo, The Daniel
K. Inouye College of Pharmacy, E-mail:
[email protected]
is to determine the effects of delivering
tobacco-prevention presentations to
elementary school students by student
pharmacists.
Methods: In March 2012, a grant
was awarded to develop and deliver a
1-hour tobacco prevention presentation
for fourth-grade students presented by
student pharmacists. Student pharmacist presenters underwent formal training before delivering presentations at
local elementary schools. Prior to training, student pharmacist presenters were
administered a 23-question survey, provided by the funding agency, inquiring
into their personal health choices (e.g.,
diet, exercise, tobacco use) and participation in tobacco-prevention and cessation programs. Pairs of student pharmacists presented 2 to 6 presentations to
classes of fourth graders during the fall
2012 semester. The same survey was readministered after the student pharmacists completed their last fourth-grade
presentation. Data were entered into
SurveyMonkey and analyzed using descriptive statistics.
Results: Thirty-one pre-presentation and 30 post-presentation surveys
were collected and analyzed. None of the
student pharmacists reported current
tobacco use in the pre- or post-surveys.
No significant differences were found in
personal health choices before training
and after delivering tobacco prevention
presentations. Before training to deliver
presentations, 12.9% of student pharmacists reported participating in community activities to discourage others their
age from using tobacco-related products,
while 70% reported participation in such
activities after delivering presentations
to fourth graders.
Conclusion: Training for and delivering tobacco prevention presentations
to elementary students was associated
with increased student pharmacist participation in tobacco avoidance activities
involving peers. Involving student pharmacists in health-related elementary
school presentations may be an effective
way to increase their involvement in other community health-related activities.
86—INCREASING THE CONFIDENCE OF GROCERY STORE–
BASED COMMUNITY PHARMACISTS IN PROVIDING DIET AND
NUTRITIONAL
COUNSELING.
Redding J, Pope N, The University of
Texas at Austin, Leckbee G, Bentley K,
Montemayor D, H-E-B, Lawson K, The
University of Texas at Austin, E-mail:
[email protected]
Objective: Grocery store chains are
striving to integrate pharmacists and
other health care professionals into a
team that provides the best patient care
and makes the stores centers for health
and wellness. Grocery store–based community pharmacists are easily accessible
to patients with questions regarding
their medications or disease; however,
patients also often have questions about
nutritional items and foods sold in the
store. The purpose of this study is to
prepare pharmacists to answer patient
questions regarding nutrition and supplements and ensure patient safety by
assessing interactions of these items with
a patient’s drugs or disease states.
Methods: This study will be submitted to the institutional review board
for approval. Pharmacists practicing
in a regional grocery store–based community pharmacy will be surveyed to
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assess their confidence, knowledge, and
frequency of recommending nutritional
products, supplements, healthful foods,
recipes, and determining drug or disease
state interactions with these items. An
educational module will be prepared
by a pharmacist and registered dietitian.
Another survey will be given to the pharmacists after completion of the education
module. The results of the 2 surveys will
be compared. The analysis will determine whether the education was effective by assessing the changes in scores on
the survey and the frequency of recommendations made regarding nutrition
and supplement products.
87—PHARMACIST-LED
EDUCATIONAL INTERVENTION ON PRESCRIBING FOR FAMILY NURSE
PRACTITIONER STUDENTS. Flavin
J, Pruchnicki M, The Ohio State University College of Pharmacy, Barker E, The
Ohio State University, Sevin A, The Ohio
State University College of Pharmacy,
Green C, Porter K, The Ohio State University, E-mail: [email protected]
study is to assess the impact of a pharmacist-driven educational intervention on
family nurse practitioner students’ prescribing skills.
Methods: This is a prospective preand post-assessment of 14-week educational intervention designed to improve
clinical and procedural aspects of prescribing in a family nurse practitioner
(NP) program. NP students enrolled in
Clinical Practicum, a blended course
combining didactic learning and clinical rotations, will participate in an online
prescribing module. All students will
have received didactic instruction on
prescription writing prior to the course,
with this activity providing additional
practice consisting of weekly patient cases with formative feedback. For each patient case, students are asked to review
a corresponding prescription or to generate a prescription for the patient. The
weekly activities will emphasize legal requirements, accuracy of the prescription,
and appropriateness of therapy based on
patient-related factors, including patient
safety considerations. The pharmacist
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APhA2014 ABSTRACTS
facilitator will provide feedback on the
students’ submissions. Before and after
completion of the module, participants
will complete a graded assessment on
prescription writing skills. The pre-assessment also will collect demographic
information. The post-assessment will
include a retrospective pre- then postsurvey to collect students’ perceptions of
how preparedness to prescribe changed
with the practice opportunities, as well
as their perceptions regarding pharmacist collaboration. Change from pre- to
post-module will be evaluated by t tests
or signed-rank tests, as appropriate. Associations with demographic factors will
be assessed using t tests, rank-sum tests,
or Jonckheere-Terpstra tests, as appropriate.
Results: Research in progress. Results are expected to demonstrate the
impact of pharmacist expertise on NP
students’ understanding of safe and effective medication prescribing. Formative education on appropriate prescribing could enhance preparedness of future prescribers, thereby improving the
medication use process and reducing errors and delays in initiating and optimizing drug therapy. Exposure of the NP
students to pharmacist expertise in this
area during training also may encourage
future collaboration in practice.
88—A PILOT PROJECT IN THE
PHARMD CURRICULUM TO ENHANCE STUDENT PHARMACIST
CONFIDENCE IN APPLICATION OF
EVIDENCE-BASED
GUIDELINES
AND MAKING PHYSICIAN RECOMMENDATIONS. Jakubek J, Konopka C, Sulkowski K, McConaha J, Lassila
H, Duquesne University, E-mail: [email protected]
is to investigate the learning of third-professional year (PY3) student pharmacists
through the application of evidencebased guidelines in making recommendations to physicians in response to care
alerts issued by third-party payers.
Methods: PY3 student pharmacists
participated in a pilot project to determine their level of confidence and degree
of learning through application of evidence-based guidelines to real-life clini-
e108 JAPhA | 5 4:2 | M AR/AP R 2014
cal scenarios. Student participants evaluated weekly care management alert letters sent to a primary care physician
group. These letters included recommendations for gaps in care according to
published guidelines, medication adherence issues, and potential drug-drug or
drug-disease interactions. Students analyzed each letter using knowledge of disease-specific clinical guidelines learned
through their didactic curriculum to
determine whether the proposed intervention was appropriate and necessary.
Students then prepared and submitted
evidence-based recommendations to a
pharmacist faculty preceptor at the physician’s office for evaluation. Recommendations deemed appropriate by the preceptor were forwarded to the physician
for consideration. Those not accepted by
the preceptor were sent back to the student with feedback. Student confidence
level with providing clinical recommendations was evaluated pre and post data
collection through a written survey. Collected data included the categorization
of the types of recommendation letters,
the number of student recommendations
that were sent for physician consideration, and number of accepted physician
recommendations. A paired t test on student pre- and post-confidence surveys
will be performed along with qualitative analysis of student comments on the
confidence survey. Descriptive statistics
will be used which include cumulative
percentages for the types of the requests,
the percent of student recommendations
that were sent for physician consideration, and the percent of accepted physician recommendations.
Results: Research in progress. Expected results will illustrate increased
confidence of the student pharmacists as
a result of the application of previously
acquired knowledge of current clinical
guidelines.
89—STUDENT READINESS TO
PROVIDE PATIENT SCREENING
AND EDUCATION IN A NATIONWIDE HEALTH AWARENESS CAMPAIGN. Layson-Wolf C, Eisenschmid A,
University of Maryland School of Pharmacy, E-mail: [email protected]
ja p h a .org
is to evaluate student perceptions regarding their readiness to participate in
patient screening and education events
during a nationwide health awareness
campaign.
Methods: Student participants in
this study were identified by their placement at particular rotation sites recruited
for the Team Up Pressure Down campaign, which focuses on identification
of patients with hypertension, referral
of patients for follow up, and provision
of education related to high blood pressure. Students were invited to participate in a pre-rotation education session
about the campaign and were e-mailed
a survey to evaluate their readiness to
provide screenings to patients at their
community rotation site and communicate to patients and health care providers
about their screening results. The university’s terminal performance outcomes
statements relevant to this activity were
used to garner their readiness for the
campaign. Data will be evaluated and reported utilizing descriptive statistics. A
follow-up survey with the students after
the campaign is also planned.
data will be utilized to structure and
design training sessions for students to
help strengthen skills in screening and
education programs provided in the
community setting.
90—TEACHING STUDENT PHARMACISTS THE IMPLICATIONS
OF ORAL HEALTH ON CHRONIC
DISEASE STATE MANAGEMENT.
Mazzarisi C, Bastin M, Steel E, Primley
C, Gersten J, Jonkman L, The University
of Pittsburgh, E-mail: caramazzarisi@
gmail.com
Objective: Student pharmacists
receive little instruction on oral health
considerations in chronic disease management. The goal of this project was
to teach student pharmacists basic information about oral health issues that
arise from certain disease states or as
complications of uncontrolled disease
states. The skills learned during this session could then be applied at a free clinic
where these students complete their service learning requirements.
Methods: Pharmacy and dental stu-
APhA2014 ABSTRACTS
dents created a teaching intervention to
increase pharmacy student knowledge
of and comfort with oral health complications of chronic diseases. Immediately
prior to the lecture, participants completed a pre-test to evaluate comfort and
knowledge. After the lecture by dental
students, the participants immediately
completed a post-test to assess improvement in knowledge and comfort. As part
of a required service learning experience,
some of the participants will have an experience at a free clinic before the end of
the semester. Participants will be asked
to complete the post-test again at the
end of the semester to assess retention.
In addition, those participants who had
a free clinic experience will complete information on how they used the material
while at the free clinic. Improvement in
knowledge and retention of knowledge
will be evaluated at the end of the study.
The institutional review board approved
this protocol.
total of 18 student pharmacists participated in the intervention. At baseline,
students scored an average of 57% (standard deviation [SD] 19%) on the knowledge test. After the intervention, knowledge increased by 25% (P<0.05). Additionally, students’ comfort level discussing oral health with patients increased
from 2.78/10 (SD 1.56) to 4.89/10 (SD
1.60) after the presentation (P<0.0001).
An additional presentation will be held
later in the semester to enroll more participants. The results of the third test will
be analyzed at the end of the semester.
Geriatrics and Long-Term Care
91—CONCORDANCE
BETWEEN
MEASURES OF POLYPHARMACY.
Goedken A, Li C, Cook E, University of
Iowa, Brooks J, University of South Carolina, E-mail: amber-goedken@uiowa.
edu
Objective: This study aims to: (1)
assess the prevalence of polypharmacy
(i.e., ≥5 medications) among elderly individuals hospitalized for acute myocardial infarction using different combinations of medication definition, categorization, and time frame; and (2) measure
the concordance between different mea-
sures of polypharmacy.
study using Medicare claims and Part D
prescription drug event files of Medicare
beneficiaries ≥66 years of age hospitalized with acute myocardial infarction
in 2007. Part D events were linked to
records in the Multum Lexicon Access
database via National Drug Code (NDC)
to identify the corresponding drug and
active ingredients. Only linkable Part D
events that were not medical supplies
were included. There were 3 definitions,
3 categorizations, and 3 time frames
used. The definitions were: (1) all medications; (2) prescription medications;
and (3) oral medications. Nine binary
measures of polypharmacy were created under each medication definition
using different combinations of medication categorization and time frame. The
categorizations were: (1) 9-digit NDC; (2)
drug; and (3) active ingredient. The time
frames were: (1) at the time of admission;
(2) 90 days prior to admission; and (3)
180 days prior to admission. The prevalence of polypharmacy using each of 27
measures was calculated. Unweighted
kappa statistics were used to measure
agreement between measures.
Results: Using all medications
available at admission, 44% to 48% had
polypharmacy depending on the categorization. When the time frame was
extended to fills 90 and 180 days prior to
admission, 65% to 69% and 74% to 77%
had polypharmacy, respectively. The
kappa statistics for a given categorization ranged from 0.39 to 0.79, depending
on the time frame. The range was similar
for alternative medication definitions.
Conclusion: The time frame used
to measure medication use has a greater impact on who has polypharmacy
than how medications are categorized.
Variation in polypharmacy prevalence
between studies is likely a function of
the period over which medication use is
measured.
92—THE EFFECT OF HOSPITALIZATION AND REGIONAL GEOGRAPHY ON THE USE OF POTENTIALLY
INAPPROPRIATE MEDICATIONS
IN OLDER ADULTS. Middendorff G,
University of Iowa, Lund B, Iowa City
j apha.org
VA Health Care System, Schroeder M,
Brooks J, University of Iowa, E-mail:
[email protected]
Objective: Potentially inappropriate medications (PIMs) are an important cause of adverse outcomes in older
adults. The objectives of this study were
to: (1) describe geographic variation in
PIM use among older adults hospitalized for acute myocardial infarction
(AMI); and (2) assess the impact of hospitalization on PIM prescribing.
Methods: Participants were selected from a 100% sample of Medicare
beneficiaries admitted for AMI during
2007–2008. Medicare Part D claims were
used to characterize PIM exposure during the 6 months prior to hospitalization
and 6 months following discharge, and
to identify PIMs discontinued or initiated around the time of admission. PIM
use was defined by the High-Risk Medications in the Elderly quality indicator
from the Healthcare Effectiveness Data
and Information Set.
Results: Of 124,051 patients hospitalized for AMI, 28,097 (22.6%) had
a PIM dispensed during the 6 months
prior to hospitalization, which varied
from 16.3% in the Northeast to 28.3%
in the South. At the time of admission,
9,607 patients had an active PIM, of
which 3,682 (38.3%) were discontinued
prior to discharge. Discontinuation rates
varied from 43.4% in the Northeast to
37.2% in the South. PIM initiation during hospitalization occurred in 4,666
(3.8%) patients and ranged from 2.2% in
the Northeast to 5.1% in the South. The
overall 6-month PIM prevalence following discharge was 24.6%.
Conclusion: This study showed significant regional variation in health care
quality among older adults admitted
for AMI. Consistent with prior outpatient studies, PIM use was lowest in the
Northeast and highest in the South. Contrary to the study hypothesis, acute hospitalization yielded a net increase in PIM
use, both during admission and in the 6
months following discharge. These findings suggest that acute hospitalizations
are a missed opportunity to improve
prescribing quality, where patients have
access to clinical pharmacists and other
services that may not be available in the
MA R /APR 2014 | 54:2 |
JAPhA e109
APhA2014 ABSTRACTS
community setting.
Health Disparities and Cultural
Issues
93—EVALUATION OF COMMUNITY PHARMACIST–MANAGED
TRANSITIONS OF CARE ON HOSPITAL READMISSION RATES IN A
MEDICALLY UNDERSERVED COMMUNITY HEALTH CENTER. Smith
R, Rickertsen H, Smith J, Doucette W,
Catney C, Veach S, University of Iowa
College of Pharmacy, E-mail: rickerth@
mercyhealth.com
is to evaluate the effect of community
pharmacist–managed transitions of care
on 30-day readmission rates for patients
receiving primary care at a collaborative
community health center for the medically underserved.
Methods: This is a longitudinal
study examining a local hospital’s 30-day
readmission rates over a 3-month period
before and after an enhanced community pharmacist–managed transition of
care model is implemented. Those rates
also will be compared with statewide
Medicare hospital readmission data.
Study participants include adults ≥18
years of age who have been admitted to a
local hospital and receive post-discharge
primary care at a 340B-qualified community health center in a mid-sized city in
the Midwest. Community health center
patients will be identified upon admission to the hospital through a form faxed
to the 340B medication access pharmacy
to obtain prescription histories. The community pharmacist will follow patients
by attending inpatient care conferences
and accessing community health center
and hospital electronic health records
from hospital admission through their
first appointment with their primary
care provider post-hospital discharge.
Pharmacist interventions will include
reconciling medication and diagnosis,
handling gaps in knowledge concerning
patient information, ensuring patients
follow up at the community health center within 3 days of hospital discharge,
and increasing access to chronic medications by utilizing 340B formulary.
The primary end point will be 30-day
e110 JAPhA | 5 4:2 | M AR/AP R 2014
hospital readmission rates of participating community health center patients.
The secondary end point will be time to
see primary care provider after hospital discharge. The 30-day readmission
rates during the 3-month service period
will be compared with those from the
3-month baseline period and a matching period using the statewide Medicare
hospital readmission data.
94—THE IMPACT OF MEDICARE
PART D ON RACIAL/ETHNIC DISPARITIES IN THE USE OF CARDIOPROTECTIVE MEDICATIONS
AMONG MEDICARE SENIORS.
Hussein M, Waters T, University of Tennessee Health Science Center, E-mail:
[email protected]
is to evaluate the impact of Medicare
Part D introduction on the racial/ethnic
disparities in the use of beta-blockers,
angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or
statins (collectively referred to as cardioprotective medications) among seniors
with cardiovascular diseases.
Methods: This is a quasi-experimental difference-in-differences analysis of
the Medical Expenditure Panel Survey
(MEPS 2002–2010). The treatment group
includes Medicare seniors. The control
group includes the near-elderly (60–64
years of age) non-Medicare respondents,
who had at least 1 of 6 ambulatory care–
sensitive cardiovascular conditions; selfreported being white, black, or Hispanic;
and were continuously eligible for MEPS
data collection. Periods 2002–2005 and
2007–2010 were designated as pre- and
post–Part D periods, respectively. The
main outcome was any refill during survey year of a cardioprotective medication. In primary analyses, survey-adjusted logistic regression was used to model
this binary outcome. A distinction was
made between differences and disparities in drug use, following the Institute
of Medicine’s 2002 framework. Minority
distributions of demographics, health
status, and beliefs were replaced by the
corresponding white distributions to
selectively adjust for these covariates,
while allowing measures of social disja p h a .org
advantage (e.g., socioeconomic status)
to contribute to estimated disparities. A
secondary analysis using the generalized
changes-in-changes (CIC) estimator assessed the heterogeneity of Part D’s effect across the outcome distribution.
Results: A sample of 17,087 respondents, nationally representing
24,237,118, was analyzed. Part D was
found to have reduced the white-black
disparity in the probability of drug use
by 12 points (95% confidence interval
[CI] –16.00, –8.00; P = 0.000), while it has
reduced the white-Hispanic disparity
by 5.5 points (95% CI –10.00, –1.00; P =
0.001). CIC models suggest that Part D’s
effect was driven by significant improvements in the lower quantiles of the distribution.
Conclusion: By netting out relevant
secular trends in disparities, this analysis suggests that Medicare Part D has
improved elderly minorities’ access to
essential cardiovascular drugs. There
remain, however, significant disparities
deserving further investigation in drug
use in the post–Part D era.
95—MISSION OF MERCY HEALTH
LITERACY AND QUALITY OF LIFE
ASSESSMENT. Lindsay D, Webb T,
Bloodworth L, Brown M, Davis C, Fleming J, Harrell K, University of Mississippi
School of Pharmacy, E-mail: lindsdyl@
gmail.com
Objective: The aim of this study was
to assess health literacy and quality of
life of participants in the state’s Dental
Association 2013 Mission of Mercy clinic
who received free dental and pharmacy
services.
Methods: Questions from the Centers for Disease Control and Prevention’s
Quality of Life survey as well as the
health screening tool, Newest Vital Sign,
were compiled into a single survey and
administered verbally to study participants. The survey was administered in
conjunction with the state’s Dental Association 2013 Mission of Mercy clinic,
which took place April 26 and 27, 2013.
This study was approved by the institutional review board.
Results: There were 242 participants
in the survey. The majority were female
(69.8%) and African American (71.7%),
APhA2014 ABSTRACTS
with a mean age of 40.8 years (range
18–80 years). A lack of medical insurance coverage was reported by 64% of
participants; a majority (41%) reported
their general health as “good,” but 28%
reported limited ability to perform usual
daily activities over the past month due
to physical or mental health problems.
The Newest Vital Sign component of
the survey was completed by 232 participants, with an average health literacy
score of 2.6 ± 1.8 (mean ± standard deviation). Only 34% had what is considered
to be “adequate” health literacy; 31%
scored ≤1, which indicates a high likelihood of limited health literacy.
Conclusion: Although a majority of
study participants reported their health
as “good,” a large percentage also reported mental and physical health problems
that were significant enough to hinder
their usual daily activities. These problems may be related to the large number
of participants who indicated a lack of
medical insurance coverage, although a
causative relationship cannot be shown
based on the data at this time. A majority of study participants also exhibited a
lack of adequate health literacy, which
may contribute to the health concerns of
the local patient population.
Health Literacy
96—ANTIBIOTIC USE AND PERCEPTION AMONG JORDANIAN
PARENTS. Athamneh L, University of
Houston, El-Mughrabi M, The Ministry
of Health, Athamneh M, Ramtha Hospital, Essien E, Abughosh S, University of
Houston, E-mail: smabugho@Central.
UH.EDU
is to explore parents’ patterns of antibiotics use for children aged 6 weeks to 6
years in Jordan, a small Middle Eastern
country.
Methods: An observational, surveybased, cross-sectional study in a convenient sample of 419 Jordanian adult parents in Irbid governorate area, Jordan.
The questionnaire consisted of 32 yes/
no and multiple-choice questions in 4
major categories that capture sociodemographic information in 1 section and
elicit information about the parent’s
knowledge, beliefs, and practices in fever
management and antibiotics use in the
remaining sections. Descriptive statistics
were presented.
Results: More than half of parents
(56%) surveyed reported giving antibiotics to their children without a pediatrician’s advice. Reasons cited include suspecting an infection (31%) or just having
a fever (21%). Thirty percent of parents
reported having obtained an antibiotic
for their child from a pharmacy without a prescription. In this study, 14% of
parents used antibiotics to treat fever in
children. The study indicated that 23%
of parents think antibiotics should be
prescribed to all children who develop
fever. Of the participant parents, 38% reported using antibiotics for their unwell
child without a consultation from a physician, 67% would use antibiotics based
on a pharmacist’s consultation, and 17%
would insist on receiving an antibiotic
prescription even when not considered
necessary by their pediatrician.
Conclusion: Findings indicate that
parents in Jordan often have false beliefs,
wrong practices, and misuse antibiotics
for their children. These results highlight
the need to develop reliable evidencebased educational programs to educate
the parents about potential harms of misuse and ultimately control inappropriate
use.
97—CORRELATION
BETWEEN
HEALTH LITERACY AND MEDICATION ADHERENCE IN INFECTIOUS DISEASE CLINIC. Turner B,
Metzger A, University of Cincinnati, Email: [email protected]
is to determine the correlation between
health literacy and medication adherence.
Methods: Patients in an infectious
disease clinic were asked 2 sets of questions at their visit; the first set of questions relates to health literacy and the
second set relates to adherence. The first
set, “The Newest Vital Sign,” is a series of
6 questions used to determine the health
literacy of the patient. The second set of
questions was developed based on existing literature on adherence and was
scored on a scale of 0 to 11. Both scales
j apha.org
were collected as part of the standard of
care for the patients at their clinic visits.
These scores were compared to meet the
stated objectives.
Results: The results showed a higher
correlation between medication adherence and health literacy in patients with
high health literacy (R2 = 0.8027). Patients
with moderate to low health literacy
had a lower correlation between health
literacy and medication adherence (R2
= 0.6566 and R2 = 0.7424). These correlations show expected results. Since medication adherence can be attributed to a
number of different factors (e.g., mental
health, financial status), health literacy
represents only part of the picture.
Conclusion: Medication adherence,
while important in all pharmacotherapy,
has an increased importance in infectious
disease, especially in patients with human immunodeficiency virus infection
due to the risk of developing resistance.
For this reason, medication adherence
is essential to monitor in patients with
chronic infectious disease. Furthermore,
ways to improve medication adherence
in this population as well as all others
should be sought. Health care providers should take the time to help improve
their patients’ medication adherence and
their health literacy. Patients with lower
health literacy may need extra time to go
over their medication directions and additional tools (e.g., reminders, pillboxes)
to achieve the same level of adherence as
patients with higher health literacy.
98—EFFECT OF FOCUSED EDUCATION ON FUNCTIONAL HEALTH
LITERACY AND PRESCRIPTION
LABEL COMPREHENSION: A RANDOMIZED CONTROLLED TRIAL.
Tai B, Law A, Western University of
Health Sciences, LaRue C, Metro North
Adult Education, E-mail: btai@westernu.
edu
study are to: (1) assess change in functional health literacy (FHL) and prescription (Rx) label comprehension of English-speaking older adults after a focused
educational intervention; (2) examine the
correlation between FHL and Rx label
comprehension; and (3) examine factors
that may predict FHL and Rx label comMA R /APR 2014 | 54:2 |
JAPhA e111
APhA2014 ABSTRACTS
prehension.
Methods: A randomized, controlled,
single-blinded trial was conducted at 3
senior centers. Inclusion criteria were:
English-speaking older adults, ≥55 years
of age; currently taking ≥2 Rx medications; and without visual, hearing, or
cognitive impairment. The 107 recruited
individuals were randomized to control
(n = 47) or intervention group (n = 60).
Pre- and post-intervention FHL levels
were measured by a validated and widely used instrument, Short Test of Functional Health Literacy in Adults (STOFHLA). Rx label comprehension levels
were measured using a 25-item instrument (with established face and content
validity), based on labels for 4 common
chronic conditions. Intervention group
received focused education (individual
counseling and printed material) on Rx
labels during the 1-month study period.
Data were analyzed using IBM SPSS version 21.
Results: Majority of the sample
(mean age, 76.7 years) was female
(59.8%), white (56.1%), completed some
college education or above (63.6%), with
annual household income <$50,000
(58.9%). No significant differences were
found between the intervention and control groups in demographics, baseline
FHL, and Rx label comprehension levels.
Reliability (internal consistency) of the
label instrument scale was at Cronbach
alpha of 0.87. Significant improvement
was seen in STOFHLA (27.5 to 31.4) and
label comprehension scores (22.8 to 24.0)
from baseline (both P<0.01), compared
with the control group. STOFHLA and
label instrument scores were significantly correlated (r = 0.628, P<0.01). Age and
education level were significant predictors for both measures.
Conclusion: A significant improvement in FHL and Rx label comprehension was observed after educational intervention. Improving Rx label comprehension may be an avenue for improving
FHL.
99—THE EFFECT OF USING PICTOGRAMS ON COMPREHENSION
OF MEDICAL INFORMATION: A
META-ANALYSIS. Ghura S, Chewning
B, University of Wisconsin–Madison, E-
e112 JAPhA | 5 4:2 | M AR/AP R 2014
mail: [email protected]
Objective: Health literacy is a growing concern among health care systems
globally. Research has demonstrated
that people with low levels of literacy
have less knowledge about their disease
and medication instructions, potentially increasing risk of nonadherence
and poorer health outcomes. Although
pictograms have been recommended to
enhance health literacy, the field lacks a
published meta-analysis of the impact of
pictograms on patient comprehension.
This meta-analysis aimed to synthesize
and analyze data from published studies
of the effect of pictorial aids on medication comprehension. The intention is to
identify avenues for further research that
can aid patient understanding of medical
information through use of visual aids.
Methods: Studies of patient comprehension included in this analysis used
a specific treatment intervention composed of medical information provided
as pictograms and text and compared
this combination with a text-only intervention, which was treated as the control. All patients in these studies were
provided medical information in the
form of a patient label, patient information leaflets, or consultation by a health
care provider. Data sets searched included Cochrane Library, EBSCO, and
PubMed. Meta-analysis was performed
using a random effects model.
Results: Out of the 139 published
studies, 12 studies were screened for
data and 9 studies were used in the
analysis. Results supported the primary
hypothesis that pictograms aid medical
comprehension (P<0.0001). The summary effect size was found to be g = 0.5
(0.19, 0.8). The I2 value for this omnibus
test was almost 88%, implying large heterogeneity in the sample. Among the
moderators tested, a patient’s number
of years of education was close to significance (P = 0.09).
Conclusion: This analysis suggests
that pictograms should be integrated
more often into educational materials,
particularly for lower education populations. Further, there is a need to explore
the relationship of medical comprehension with other outcomes such as medication adherence and health outcomes.
ja p h a .org
100—HEALTH LITERACY, MEDICATION ADHERENCE, AND PATIENT
SATISFACTION IN COMMUNITY
PHARMACY. Anderson S, Chen A, Cedarville University, E-mail: sanderson@
cedarville.edu
study are to: (1) determine whether pharmacists’ perception of patient health literacy and actual patient health literacy
align; (2) assess the relationship between
health literacy and medication adherence in patients who visit independent
community pharmacies; and (3) evaluate
patients’ satisfaction with their pharmacists’ patient counseling.
Methods: Inadequate health literacy
has been shown to result in negative
outcomes, including poor medication
adherence. Bridging the gap between
the pharmacists’ communication and
patients’ level of understanding is crucial
in improving patients’ overall care. At
every refill, pharmacists have an opportunity to break the health literacy barrier,
therefore, improving medication adherence. However, there may be a disconnect in the pharmacists’ opinion of their
patients’ health literacy and satisfaction
with counseling. Local, independent
pharmacies were recruited using convenience sampling. Patients who are ≥18
years of age, speak English, and are obtaining a refill for a chronic condition will
be asked to complete several instruments
to assess health literacy (Newest Vital
Sign), medication adherence (8-item
Morisky Medication Adherence Scale),
and patient satisfaction with counseling
(Likert-type, 5-point agreement scale).
Pharmacists will complete an instrument
assessing their perceptions of patient
health literacy, medication adherence,
and counseling satisfaction. The patient
satisfaction and the pharmacist perceptions surveys were created from an indepth literature review and underwent
non-expert, peer, and expert review to
establish face and content validity. Survey results will be analyzed in SPSS with
alpha = 0.05. To achieve beta = 0.2, approximately 60 patients will be recruited
per site.
Results: Research in progress. Thus
far, 6 independent community pharmacies have been recruited in both un-
APhA2014 ABSTRACTS
derserved urban and rural areas. Data
collection is currently underway with
anticipated completion by the end of
December 2013. Results from this project can be utilized to educate these and
other pharmacists on possible ways to
improve patient care by counseling in a
way all patients can understand.
Q 101—IMPACT OF HEALTH LITERACY IN A DIABETES SELFMANAGEMENT EDUCATION PROGRAM. Smith S, Shealy K, Threatt T,
Presbyterian College School of Pharmacy, E-mail: [email protected]
was to: (1) determine whether baseline
health status correlates to a patient’s
health literacy level as indicated by A1C;
(2) determine health literacy level correlates to health outcomes as indicated by
A1C level at follow up; and (3) determine
health literacy level correlates with attendance in diabetes self-management education (DSME) program.
Methods: This cohort study assessed
patient health literacy status using the
Rapid Estimate of Adult Literacy in
Medicine–Short Form (REALM-SF) and
Newest Vital Sign (NVS) tools during
initial consults with patients referred to a
DSME program. Additional data collected included demographic information
and baseline A1C. Follow-up A1C was
compared with baseline. Attendance
was determined by number of missed
classes. Descriptive statistics were used
to analyze the data collected; change in
A1C was analyzed by paired Student t
test and correlation coefficients (r) were
calculated for attendance and A1C level
by health literacy level. This study was
board. Informed consent was obtained.
Results: Thirty-nine patients were
enrolled in the study. More patients were
identified to have poor health literacy
with NVS than with REALM-SF. No significant correlation was found between
baseline health status and health literacy
level. Significant reduction in A1C was
seen in all patients; however, follow-up
health status per A1C negatively correlated with NVS scores. Patients with
poor health literacy missed an average of
2.4 appointments, compared with an av-
erage of 1.3 missed appointments by patients with higher health literacy. Scores
from REALM-SF negatively correlated
with attendance and were statistically
significant.
Conclusion: Overall the DSME program successfully improves patients’
health, and health literacy level seems
to affect attendance to DSME sessions.
the optimal tools for assessing health literacy level and subsequent interventions
to achieve health outcomes success in a
DSME program.
Original Citation: Smith S, Shealy
KM, Threatt T. Impact of health literacy
in a diabetes self management education
program administered through a school
of pharmacy. Presented at 19th Annual
Diabetes Fall Symposium for Primary
Health Care Professionals, Charleston,
SC
102—THE INFLUENCE OF FUNCTIONAL HEALTH LITERACY ON
QUALITY PATIENT-PHARMACIST
COMMUNICATION. King S, Union
University, Rogers E, Methodist Healthcare, Null K, University of Mississippi,
was to examine the relationship between
functional health literacy (FHL) and
quality patient-pharmacist communication among patients receiving anticoagulation therapy. Additionally, this study
assessed whether the time patients spent
within optimal therapeutic range differed by level of FHL.
Methods: In this study, 232 patients from 2 rural, pharmacist-staffed
anticoagulation clinics were asked to
participate in detailed telephone interviews concerning their interactions with
clinic pharmacists. A validated, 1-item
screening question was used to classify
patients as possessing either adequate
or inadequate FHL. Patients’ perceptions regarding general communication
with pharmacists were elicited using 6
domains from the Interpersonal Process
of Care (IPC) questionnaire. Indication,
target range, time in range of anticoagulation, and race/ethnicity were retrieved
from the database of the respective clinic.
Independent t tests were used to assess
j apha.org
for differences between FHL groups on
each of the 6 IPC domains. Logistic regression was used to measure the association between inadequate FHL and the
IPC domains.
Results: Telephone interviews were
completed by 220 patients. Patients possessing inadequate FHL reported significantly worse ratings to the quality
of pharmacist communication than did
those possessing adequate FHL on 4 of
the 6 IPC domains (P≤0.05). The odds of
reporting poorer quality interpersonal
processes of care across these 4 domains
were significantly greater for those possessing inadequate FHL (P≤0.05). Patients with inadequate FHL did not differ
significantly from those with adequate
FHL in terms of time within therapeutic international normalized ratio (INR)
range or percent of INRs in therapeutic
range over the previous 12 months.
Conclusion: Patients receiving anticoagulation therapy also possessing
inadequate FHL appear more likely to
experience poorer communication with
pharmacists than patients possessing
adequate FHL. Pharmacists may be failing to adequately determine the extent
to which educational efforts for these
patients leads to intended consequences.
Educational efforts may be needed to
improve pharmacists’ communication
skills in these areas.
103—READERSHIP AND PERCEPTION OF MEDICATION GUIDES
AND PATIENT PACKAGE INSERTS
AT A STUDENT HEALTH PHARMACY. Buchman C, Boyce B, Muravez S, Oregon State University, E-mail: christina.
[email protected]
Objective: The printed Medication
Guide (MedGuide) and Patient Package Insert (PPI) that are required with
prescription drugs outline the risks of
taking the medication in language that
is patient-friendly and relatively easy to
read. The aim of this study is to evaluate
how often patients of a student health
pharmacy read the MedGuides/PPIs
of prescription medications and how
useful they have found the information
provided. The unique patient population
of a university setting eliminates some
potential confounders because it can be
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APhA2014 ABSTRACTS
assumed that students, staff, and faculty
who make up the patient base will have
a high enough level of education to be
able to read and comprehend the handouts. Based on pre-study observation, it
is proposed that patients may read the
information when first presented, but
not when they receive it with refills of the
same medication. If this study shows low
readership of MedGuides/PPIs, then
pharmacists will need to be more vigilant
about counseling regarding the purpose
of the handouts as well as watching for
adverse effects and drug-drug interactions.
Methods: The study plans to enroll
the first 1,500 patients who present to the
student health pharmacy for a refill of a
medication that requires a MedGuide
or contains a PPI. Patients who are ≥18
years of age and are requesting a refill
of a medication that has been previously
filled at the student health pharmacy and
requires a MedGuide or contains a PPI
will be handed a survey to fill out while
they wait for their prescription. The survey will evaluate whether they recall
receiving a MedGuide or PPI with their
last prescription and whether they read
it. The survey also will attempt to evaluate their perception of the information
by asking about understandability, usefulness, length, and how confident they
are about the information in the handout.
Data from the survey will be compiled
and reported in aggregate form using a
descriptive statistical analysis.
Immunizations
104—ADDRESSING BARRIERS TO
PNEUMOCOCCAL VACCINATION:
TRAINING PHARMACY TECHNICIANS FOR ROLES IN VACCINE
ADVOCACY. Humphries C, University
of North Carolina at Chapel Hill Eshelman School of Pharmacy, Gatton O,
Cates L, Kroger, Ferreri S, Marciniak M,
University of North Carolina at Chapel
Hill Eshelman School of Pharmacy, Email: [email protected]
Objective: According to the Centers for Disease Control and Prevention,
approximately 70 million people have
indications for pneumococcal vaccine
e114 JAPhA | 5 4:2 | M AR/AP R 2014
but remain unvaccinated. Patient understanding of pneumococcal vaccine recommendations is likely a large barrier to
vaccination. Due to their significant role
in the medication use system, pharmacy
technicians may be a valuable resource
to facilitate communication about pneumococcal vaccine. However, pharmacy
technicians ability to initiate vaccine
conversations with patients also may be
a barrier to increasing vaccination rates.
The purpose of this study is to determine
the impact of involving pharmacy technicians on vaccination rates.
Methods: This prospective cohort
study will take place in a grocery store
pharmacy chain. Four pharmacy technicians at the intervention store will take
part in a 1-hour educational session
about pneumococcal disease and vaccine. Resources will be created for the
technicians to support patient encounters, including a flowchart for flagging
potential vaccine candidates, a handout
with educational points (“script”) for
initiating discussion with the patients,
and bag stuffers to inform patients about
vaccine eligibility. Technicians will be
trained to target the following individuals: patients ≥65 years or patients ≥18
years with asthma, cardiovascular disease, chronic obstructive pulmonary
disease, or diabetes mellitus. Technicians
will track the number of pneumococcal
vaccination encounters each week and
the number of bag stuffers distributed.
A store with the same number of technicians and similar patient demographics
will serve as the comparison site. Paired
Student t test will be used to compare
pneumococcal vaccine rates prior to and
following technician training for both
stores; t test will be used to compare
pneumococcal vaccine rates between the
intervention and control stores at the end
of the study.
Results: Research in progress. Institutional review board approval is
anticipated in October 2013. Pharmacy
technicians will be trained in November
2013 and data collected through February 2014.
105—ASSESSING PATIENT PREFERENCES FOR INFLUENZA VACCINE DOSAGE FORMS. Bailey J, Choi
ja p h a .org
J, Higginbotham S, Duquesne University, Skomo M, Duquesne University
Mylan School of Pharmacy, E-mail: [email protected]
study are to: (1) evaluate patient preferences related to the administration
of available influenza vaccine dosage
forms among subsets of the population
as defined by sex, age, race, socioeconomic status, and education; (2) analyze
the potential influence on dosage form
selection from contributing factors such
as pre-administration anxiety, perceived
post-administration side effects, variable
cost, and response to previous dosage
forms received; and (3) assess post-administration patient response to the dosage form chosen and its effect on future
dosage form selection.
Methods: The study is a non-experimental descriptive exploratory study
that seeks to survey patient preferences
with an anticipated sample size of 500
participants. This study will survey patients scheduled to receive the seasonal
influenza vaccine through the Center
for Pharmacy Services, the Center for
Pharmacy Care, Spirit of Health mobile
unit, and related vaccination community events throughout the Pittsburgh
area that are coordinated through these
organizations. Participants will include
adults 18 to 80 years of age in accordance
with the collaborative agreement regarding who are eligible to receive the seasonal influenza vaccine (per Centers for Disease Control and Prevention guidelines).
The questionnaires developed include a
written pre-vaccination patient preferences survey and a follow-up survey
assessing post-vaccination satisfaction
given orally via telephone interview 1
week after vaccination. Completed questionnaire data and type of vaccine delivery used will be collected and collated by
category.
Results: Research in progress. Participants are currently being recruited.
Descriptive and inferential statistics
including chi-square will be employed
to analyze respective data collected as
related to sex, age, race, socioeconomic
status, factors that influence pre-administration dosage form selection, post-administration response to the dosage form
APhA2014 ABSTRACTS
received, and patient preferences for future dosage form selection.
106—COMMUNITY PHARMACIST
IMPACT ON HEPATITIS B VACCINATION RATE IN PATIENTS WITH
DIABETES. Strain J, Virginia Commonwealth University, Harrison A, Kroger
Pharmacy, Moczygemba L, Goode J,
study are to: (1) determine the hepatitis
B vaccination rate of patients with diabetes before and after community pharmacist education and intervention; and
(2) assess patients’ awareness of the recommendation that adults aged 19 to 59
years with diabetes receive the hepatitis
B vaccine.
Methods: Providers and patients
may still be unaware of the 2011 Advisory Committee on Immunization Practices (ACIP) recommendation that unvaccinated patients with diabetes receive
the hepatitis B vaccine. Pharmacists have
an opportunity to intervene and educate
these patients. Approximately 300 patients, aged 19 to 59 years with diabetes,
will enroll in this prospective study. The
intervention will be conducted at 10 locations of a national supermarket chain
pharmacy in the Richmond, Virginia,
area over a 3-month period. Patients will
be identified for recruitment if they filled
a diabetes medication in the last 90 days.
The pharmacist will provide verbal and
written education to the eligible patient.
Patients will complete a 1-page survey
to determine demographics, baseline
hepatitis B vaccination status, awareness
of the recommendation, and interest in
receiving the hepatitis B vaccine. Baseline hepatitis B vaccination rate will be
determined by the number of patients
who self-report any doses of hepatitis
B vaccine. Final vaccination rate will be
determined by adding the number of patients who were vaccinated at baseline to
the number of patients who received at
least 1 dose of vaccine during the study.
Baseline and final vaccination rates will
be compared among groups based on
demographic factors, prior knowledge
about the vaccine, and willingness to receive the vaccine at a pharmacy. Descrip-
tive (means, frequencies, and standard
deviations), bivariate (chi-square), and
multivariate (logistic regression) statistics will be used for the data analysis in
this study.
107—EVALUATING THE IMPACT
OF A PHARMACY-BASED INTERVENTION ON ELDERLY PATIENTS’
VACCINATION RATES IN A STATE
THAT REQUIRES A PRESCRIPTION
FOR VACCINE ADMINISTRATION.
McCoy L, University of Georgia, Howell
L, Village Drug Shop, Bourg C, Young H,
University of Georgia, E-mail: mccoyrx@
gmail.com
study is to evaluate the impact of a
pharmacy-based intervention on pneumococcal and zoster vaccination rates in
elderly patients in a state that requires a
prescription for pharmacists to administer vaccines other than influenza.
Methods: This study will use a
between-subjects experimental design.
Study inclusion criteria include patient
age ≥65 years and eligibility for pneumococcal or zoster vaccinations. Participants will be randomized into 1 of 3
groups. Group 1 participants will receive
education (from a pharmacist or pharmacy intern) about the vaccine they are
eligible to obtain, and their physicians
will be contacted for a prescription to
authorize administration of the recommended vaccine at the pharmacy. Group
2 participants will be mailed information
(Vaccine Information Statements provided by the Centers for Disease Control and
Prevention) about recommended vaccines and prompted to speak with their
physician about receiving the vaccine.
Group 3 will serve as a control. Pre- and
post-intervention telephone surveys will
be conducted. The pre-intervention surveys will assess vaccination history and
barriers to receiving vaccinations. Postintervention surveys will be conducted
3 months after the intervention to assess
whether vaccinations were received, the
location where vaccines were received
(pharmacy, physician’s office, or other),
and if vaccination was not received, the
barriers encountered. An analysis of
variance test will be conducted to exam-
j apha.org
ine the difference in vaccinations across
the 3 experimental groups and post-hoc
tests to evaluate the differences between
the individual groups.
Results: Research in progress. Approximately 340 patients have been identified as potential study participants,
allowing for approximately 113 subjects
randomized into each of the 3 groups.
Additional results are in progress.
108—EVALUATING THE MOTIVATION OF PATIENTS TO BE VACCINATED AFTER A COMMUNITY
PHARMACIST’S RECOMMENDATION. Choi J, Machado M, Mistry A,
Massachusetts College of Pharmacy and
Health Sciences University–Boston, Email: [email protected]
is to evaluate the motivation of community patients to receive or not receive
Advisory Committee on Immunization
Practices (ACIP)-recommended adult
vaccinations after being screened by a
community pharmacist.
Methods: A community pharmacist will screen patients coming to the
community pharmacy to receive ACIP
vaccinations for which they are eligible.
Patients will be required to complete
a vaccination administration record
form and a comprehensive vaccination
screening sheet. Based on both forms, the
pharmacist will make the recommendation for the necessary vaccinations. If the
patient requires additional vaccinations,
the patient will be asked to participate in
the study. If the patient consents, he or
she will be asked to fill out Questionnaire
#1 (will participate in study, not receive
vaccination) or Questionnaire #2 (will
participate in study, receive vaccination).
After completion of Part 1 of Questionnaire #2, the community pharmacist will
counsel the patient on the vaccination(s)
that will be given. After the vaccination
is given, the patient will be asked to complete Part 2 of Questionnaire #2. Patients
will be followed up 1 month after receiving their vaccination to assess basic vaccination knowledge via a true-or-false
questionnaire created by the researcher.
Patients will be called or followed at the
pharmacy to obtain this information. After 3 attempts of calling the patient and
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APhA2014 ABSTRACTS
after 2 months of tracking the patient at
the pharmacy, patient data will be lost.
109—EVALUATION OF A VACCINATION EDUCATION PRESENTATION IN THE AGING POPULATION. Truong J, Wilhelm M, Kerr T,
Southern Illinois University Edwardsville, E-mail: [email protected]
Objective: There is a lack of data that
details the knowledge of the aging population’s understanding of vaccination
requirements and the indication of each
vaccine. The objectives of this study are
to determine older adults’ knowledge
of common vaccines needed for the aging population and evaluate a vaccination education presentation provided to
older adults.
Methods: A vaccination presentation targeted toward older adults
(aged ≥65 years old) was developed.
An 11-question data collection tool was
developed to administer an anonymous
written pre- and post-vaccination knowledge quiz. The knowledge quiz contained questions related to the patient’s
familiarity with influenza; tetanus, diphtheria, acellular pertussis; herpes zoster;
and pneumococcal vaccinations. Age of
the subject was the only demographic
data collected. Knowledge quizzes were
distributed to subjects at a vaccination
education presentation at various senior
centers and assisted living facilities. The
study was approved as exempt research
by the institutional review board.
Results: A total of 6 vaccination
education presentations were given.
Eighty-two out of 144 subjects completed the pre- and post-knowledge quiz
for a response rate of 56.9%. Mean quiz
scores on the pre- and post-knowledge
quiz was 6.7 ± 2.0 and 8.2 ± 2.0 out of 10,
respectively. Forty-one of the 82 subjects (50%) stated that the vaccination
education presentation increased their
knowledge of vaccinations, 34 subjects
(41.5%) stated that their knowledge was
unchanged, and 7 subjects (0.1%) chose
not to answer.
Conclusion: Implementation of a
vaccination education presentation in
the aging population increased subjects’
overall knowledge of vaccinations.
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110—EXAMINING THE ASSOCIATION BETWEEN RISK-TAKING BEHAVIOR AND HUMAN PAPILLOMA VIRUS VACCINATION STATUS.
Rivera D, Eworuke E, Hartzema A, University of Florida, E-mail: drsimpson@
ufl.edu
Objective: The human papillomavirus (HPV) vaccine is a relatively new
treatment for the prevention of cervical
cancer. The high prevalence of HPV is a
public health concern and data on vaccination rates indicate a recent decline.
Understanding the factors associated
with not receiving the vaccine are key to
targeting the at-risk population. The objective of this study is to understand the
relationship between risk-taking behaviors and HPV vaccination status, with
the potential to define characteristics
of the population not being vaccinated.
This can provide greater understanding,
awareness, and ability to reduce the burden of various cancers caused by HPV.
Methods: The data utilized is from
the National Health and Nutrition Examination Survey for 2009–2010 administered by the Centers for Disease
Control and Prevention. A multivariate
logistic regression model is planned including multiple imputation for missing
data to ensure proper analysis. Complete
case analysis and imputation are will be
included in the results. Variables include
condom use, number of partners, drug
use, insurance, and other health behaviors.
Results: Research in progress. A detailed analysis is going to be conducted
in SAS 9.3. The data are already available. The study is pending institutional
review board approval.
111—EXPANDING VACCINE SERVICES IN THE COMMUNITY: PATIENT PERCEPTIONS AND THE
IMPACT OF PHARMACISTS PROVIDING VACCINATION RECOMMENDATIONS. Varner E, LaysonWolf C, University of Maryland School
of Pharmacy, Healy M, Keeley D, Cary
R, Leikach N, Catonsville Pharmacy, Email: [email protected]
Objective: The purpose of the study
is to assess the impact of pharmacists
actively screening patients and providja p h a .org
ing recommendations on vaccine administration rates. The objectives of this
study are to: (1) determine patient and
physician acceptance rates of pharmacist
vaccine recommendations; (2) describe
patient perceptions of pharmacists as
vaccination providers; and (3) identify
missed vaccination opportunities.
Methods: The study is designed as
a prospective, descriptive survey study
that will be conducted at 2 independent
community pharmacies. Both pharmacies are currently participating in a vaccination initiative that involves screening
adults who receive a 2013–14 influenza
vaccine for herpes zoster and/or pneumococcal eligibility, providing counseling and recommendations to the patients, and communicating those recommendations with the patient’s provider
to obtain a prescription and administer
the vaccines. Data used for the study
will be collected using 2 forms: a screening/consent form and a vaccine eligibility questionnaire (VEQ). The VEQ also
surveys patients on their perceptions of
pharmacists as vaccine providers and
sources of vaccine information. For the
study, acceptance of pharmacist recommendations for vaccinations will be measured. The number of herpes zoster and
pneumococcal vaccines administered
during the study will be compared with
the number of each vaccine administered
during the same time period last flu season in order to determine if the active
screening and providing recommendations improved vaccine administration.
Data collected will be evaluated using
descriptive statistics.
data collected from this study will help
improve immunization practices at the
community pharmacy sites and will help
evaluate the effectiveness of pharmacist immunization recommendations in
growing immunization rates at the practice sites.
112—FACTORS
ASSOCIATED
WITH VACCINATION STATUS
AND LIKELIHOOD TO ACCEPT
VACCINE RECOMMENDATION ON
ZOSTER VACCINE IN COMMUNITY PHARMACIES. Teeter B, Westrick
S, Garza K, Stevenson L, Williamson M,
APhA2014 ABSTRACTS
Auburn University, Harrison School of
Pharmacy, E-mail: [email protected]
study are to: (1) describe patient awareness of shingles, its vaccine, and vaccination status; (2) identify factors associated
with vaccination status; and (3) determine the likelihood of being vaccinated
after the educational session.
Methods: A cross-sectional design
with a convenient sample of participants aged ≥60 years in 50 community
pharmacies in Alabama and Florida
was utilized. During the introductory
pharmacy practice experience in summer 2013, 137 immunization-certified
student pharmacists interviewed participants about shingles and provided brief
education on shingles and its vaccine to
unvaccinated participants. A structured
interviewer-administered questionnaire
and Vaccine Information Statement were
used. Descriptive statistics were used to
describe patient awareness and vaccination status. Logistic regression identified
awareness and demographic factors associated with vaccination status. Lastly,
percent of unvaccinated patients who
were likely to obtain vaccination after the
educational session was reported.
Results: Of the 688 participants,
the majority were female (57.4%) and
white (84.3%). Many heard of shingles
(93.9%) and the vaccine (81.8%). While
68% knew that zoster vaccine was recommended for people aged ≥60 years,
only approximately one-quarter (26.2%)
were vaccinated. In the logistic regression, patients 65 to 74 years of age (compared with the group 60 to 64 years of
age), those who received influenza vaccine, those who heard of the vaccine, and
those who were aware of the recommendation were more likely to be vaccinated.
Lastly, after the educational session, 358
(71.5%) of 501 unvaccinated patients said
they would “definitely” or “probably”
speak with their physician or pharmacist
about getting vaccinated. Of those 358,
96 (26.8%) said they would like to speak
with the pharmacist about receiving the
vaccine that day.
Conclusion: Although the majority
of participants had heard of shingles and
the vaccine, very few were vaccinated for
this disease. Speaking to someone about
shingles and the zoster vaccine may increase interest in receiving the vaccine.
113—HEALTHY PEOPLE 2020: IMPACT OF SCREENING AND IMMUNIZATION SERVICES ON PATIENTS WITH DIABETES IN THE
COMMUNITY PHARMACY SETTING. Rood J, University of Iowa, Osterhaus M, Osterhaus Pharmacy, Polgreen
L, University of Iowa, Farris K, University of Michigan, Veach S, University of
Iowa, E-mail: [email protected]
study are to demonstrate the ability of
community pharmacists, using Advisory Committee on Immunization
Practices (ACIP) recommendations, to:
(1) identify patients with diabetes who
are not up to date with immunizations;
(2) bring up to date those patients with
diabetes who are not up to date either
through pharmacy services or referral to
physician services; and (3) identify barriers when pharmacist intervention is unsuccessful.
Methods: This will be a prospective,
single group project implemented at an
independent community pharmacy in
a rural Midwest town. Patients flagged
for participation will be ≥18 years of age
who are either documented in the pharmacy processing system as having diabetes or fill any Food and Drug Administration–labeled diabetic medications. An
ACIP-based screening tool was developed to determine which vaccinations
each patient with diabetes requires. The
Iowa Immunization Registry Information System, with supplementary data
from physicians or patient report, will be
used for screening. During dispensing,
flagged patients will be targeted by pharmacists for any recommended vaccinations. Patients who do not visit the pharmacy directly or often will be mailed
letters to market services. Any patients
who do not respond to letters will be
contacted by phone. All patients who
agree will be immunized in the pharmacy or referred to physician care if necessary. Patients will be categorized and
documented as: (1) up to date on ACIPrecommended immunizations; (2) not
up to date on ACIP-recommended immunizations and (a) brought up to date
j apha.org
through pharmacy services, (b) brought
up to date through pharmacist referral to
physician services, or (c) not brought up
to date. Reasons for referral to physician
services and any preventative barriers
will be documented. Descriptive statistics will be reported.
Results: Research in progress. Approximately 340 patients with diabetes
have been identified.
114—IDENTIFYING
BARRIERS
TO HEPATITIS B VACCINATION
IN PATIENTS WITH HIV. James A,
Schnucks Specialty Pharmacy, Gattas
N, St. Louis College of Pharmacy, Ring
J, Schnucks Specialty Pharmacy, E-mail:
[email protected]
Objective: A vaccine is available
to prevent infection with hepatitis B virus (HBV), however despite this major
advancement, liver disease has become
one of the leading causes of deaths unrelated to acquired immunodeficiency
syndrome in patients with human immunodeficiency virus (HIV) infection.
The objective of this study is to identify
barriers to HIV-positive patients receiving hepatitis B vaccine.
Methods: Barriers to vaccination
will be investigated from the patient
and provider perspectives. Patients
will be identified via chart review at the
time of their visit with their primary
care provider and will complete a verbal questionnaire from the investigator.
Patients are considered eligible if they
are >18 years of age, HIV-positive, have
not completed the HBV vaccination series, and do not have immunity against
HBV. Eligible providers include nurse
practitioners, physician assistants, pharmacists, and physicians who work with
HIV-positive patients. The investigator
will complete a key informant interview
with providers. Barriers will be categorized and reported. Descriptive statistics
will be used to quantitatively summarize
the data collected. Identified barriers will
be compared between the 2 groups.
Results: Research in progress. Results are pending institutional review
board approval. Previous studies have
identified barriers to vaccination in the
general population, however limited
studies have specifically investigated paMA R /APR 2014 | 54:2 |
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APhA2014 ABSTRACTS
tients with HIV. These patients are at an
increased risk of transmission and complications from HBV. Once barriers are
identified, the process of breaking them
down can begin. Increased vaccination
for HBV in this subpopulation can help
decrease the spread of the virus with the
hope of eradicating it in years to come.
Data collected from this study also may
identify barriers to other subpopulations
as well as other vaccinations.
115—IMMUNIZATION RATES AND
BARRIERS TO INFLUENZA VACCINE ACCESS IN THE COMMUNITY PHARMACY. Rodriguez N, Nova
Southeastern University College of Pharmacy, E-mail: [email protected]
Objective: Healthy People 2020
objectives include increasing the percentage of children and adults who are
vaccinated annually against seasonal
influenza. In Puerto Rico, 1.6 million
people have the health plan provided by
the government. Government health insurance provides coverage for influenza
vaccine with a $0 copayment. However,
during the 2012–13 influenza season, only 10% of the government health insurance population was vaccinated. During
the 2013–14 influenza season the goal of
the Department of Health is to vaccinate
200,000 people against influenza before
December 2013. The aim of this study is
to determine the influenza immunization rate of the government health insurance population in a community pharmacy. A secondary outcome is to assess
the factors that influence access to the
influenza vaccine in Puerto Rico.
Methods: This descriptive study will
be conducted in the community pharmacy setting. A sample of patients who
visit the community pharmacy and are
beneficiaries of the government health
insurance (Mi Salud) will be assessed.
Data will be collected using a structured
questionnaire based on patients’ selfreported information. The information
provided by patients will be confirmed
using the Puerto Rico Immunization
Registry. Age, sex, socioeconomic status,
highest scholarly degree reached, and
previous influenza immunization experience will be assessed variables. The
primary outcome is influenza immuni-
e118 JAPhA | 5 4:2 | M AR/AP R 2014
zation for current season. The secondary
outcome to be evaluated will be reasons
for not becoming immunized against
influenza this season such as: allergy to
chicken eggs, history of Guillain-Barré
syndrome, moderate to severe illness
with fever, a history of severe reaction to
flu vaccine, cost, fear of needles, beliefs,
adverse effects, and other reasons that
patients report. Data analysis will be using descriptive statistics.
116—THE IMPACT OF AN IMMUNIZATION NEEDS ASSESSMENT
TOOL IN A COMMUNITY PHARMACY SETTING ON ADULT NONINFLUENZA
IMMUNIZATION
RATES. Focht J, Ray L, Kroger Co.,
Snyder M, Purdue University College
of Pharmacy, E-mail: jennifer.focht@
kroger.com
study are to: (1) evaluate the impact of an
adult immunization needs assessment
on adult vaccination rates; and (2) identify patterns in types of non-influenza
vaccinations administered to adults in
the community pharmacy setting.
Methods: Using the Advisory Committee on Immunization Practices current recommendations, an adult immunization needs assessment (AINA) was
created to be utilized in the community
pharmacy setting. Twenty-nine community pharmacy locations within a
large, national grocery store chain were
randomized to either usual care or to use
of the AINA during the study period.
While dropping off prescriptions at intervention pharmacies, adult patients
will be asked a series of questions based
on the AINA to identify potential vaccination needs. The pharmacist will discuss the identified needs with the patient
during prescription pickup. Following
the conversation, the pharmacist will fill
out a short questionnaire regarding the
interaction with the patient, including
any subsequent vaccines administered.
The number of non-influenza immunizations administered over a 4-month
period will be compared with the number of immunizations administered during the same time frame in 2012–2013. A
percentage change in non-influenza imja p h a .org
munizations administered will be calculated and compared between control and
intervention pharmacies. The questionnaire regarding the pharmacist’s interaction with the patient will be analyzed to
identify patterns in patient acceptance or
declination. Additionally, pharmacy associates participating in the intervention
will be asked to complete a survey regarding their experience with the implementation of the AINA into workflow.
Parametric and nonparametric analysis
will be used as appropriate, with institutional review board approval.
117—IMPACT OF A TARGETED
INTERVENTION PROGRAM ON
THE TETANUS TOXOID, REDUCED
DIPHTHERIA TOXOID, AND ACELLULAR PERTUSSIS (TDAP) VACCINATION RATE IN THE COMMUNITY PHARMACY SETTING. Link
S, The Ohio State University, Green T,
Kroger Co., Woods J, Rodis J, The Ohio
State University, E-mail: link.197@osu.
edu
this study is to determine the effect of a
targeted intervention program on the
number of patients who receive a tetanus toxoid, reduced diphtheria toxoid,
and acellular pertussis (Tdap) vaccine.
Secondary objectives are to: (1) compare
the effectiveness of telephonic and faceto-face interventions on the number of
patients receiving Tdap vaccines; and (2)
identify which patient population (e.g.,
parents, grandparents, siblings, caregivers) is more likely to receive the Tdap
vaccination following the educational
intervention.
Methods: Over the past year, the
number of pertussis cases and pertussisrelated deaths in the United States has
almost doubled. Multiple opportunities
exist for community pharmacists to improve awareness and impact vaccination rates. For this targeted intervention
program, reports are generated from a
community pharmacy computer system
for women who filled a prescription for
prenatal vitamins or folic acid supplements within the past 21 months and
children ≤12 months of age. The reports
will identify pregnant women and indi-
APhA2014 ABSTRACTS
viduals in close contact with children ≤12
months of age for whom the Tdap vaccine is indicated. A telephonic or face-toface intervention is performed for each
identified patient or legal guardian in
order to: (1) educate about pertussis and
the Tdap vaccine; (2) assess interest in receiving the Tdap vaccine; and (3) identify
additional family members, caregivers,
or close contacts who are indicated to
receive the Tdap vaccine. Two follow-up
telephonic surveys are conducted 1 and
2 months after the initial intervention to
assess stated objectives. Data from this
institutional review board–approved
study is analyzed using descriptive statistics.
will report the effect of telephonic and
face-to-face interventions on Tdap vaccination rates in a community pharmacy.
The results of this study will describe the
impact of community pharmacy–based
targeted intervention programs on public awareness of pertussis and the Tdap
vaccine as well as guide future initiatives
to improve vaccination rates.
118—PALIVIZUMAB
PERFORMANCE IMPROVEMENT INITIATIVE IN A NEONATAL INTENSIVE
CARE UNIT SETTING. Guerra J, Ligniti E, Rumore M, Cohen Children’s Medical Center, E-mail: [email protected]
Objective: The palivizumab program goals are to streamline efficacy and
reduce costs for the inpatient neonatal
intensive care unit population at a level
3 regional neonatal center in New York.
Palivizumab is a monoclonal antibody
used to prevent respiratory syncytial
virus (RSV) in high-risk infants and children <2 years of age at a dose of 15 mg/
kg intramuscular injection once monthly
for 3 to 5 doses. Costs are approximately
$1,200 and approximately $2,200 per 50
and 100 mg vial, respectively; unused
portions must be discarded after 6 hours.
Methods: A protocol was developed
for order cutoff times and batch production 3 times weekly (Mondays, Wednesdays, and Fridays). Inventory and budgetary control were initiated. Tracking
methods for palivizumab use were instituted. A signature log increased accountability for doses dispensed. A policy for
eligibility criteria for prophylaxis (i.e.,
compliance with the latest American
Academy of Pediatrics [AAP] Guidelines) was developed and strictly enforced by pharmacy clinical coordinators
and lead pharmacists. A Pediatric Pharmacy Bulletin was distributed to clinicians regarding the initiative. Pharmacy
staff was in-serviced regarding operational and clinical issues. A medication
utilization evaluation was conducted
from November 2011 through April 2013
on policy adherence and syringe cost
savings.
Results: Through pharmacy interventions, 100% compliance with the
policy was achieved. The policy requirement for approval by infectious disease
attending for palivizumab orders outside AAP-recommended indications
virtually eliminated inappropriate usage
and ensured eligible candidates received
1 dose prior to discharge only. The average monthly compliance with the batching protocol was 90.3%; 304 doses were
dispensed for the 2 RSV seasons studied
resulting in a cost savings of $82,623.
Conclusion: The program resulted
in less waste and improved accountability with fewer missing doses. Patient
safety was improved in the process by
dispensing patient-specific syringes instead of vials. This successful pharmacy
initiative will be continued annually
during RSV season. Future expansion to
outpatient clinics is planned.
119—PERCEPTIONS AND BARRIERS TO ADULT IMMUNIZATIONS:
A STUDY ON A DIVERSE, MULTILINGUAL, URBAN COMMUNITY.
Rodis J, Sevin A, Gagne B, The Ohio State
University College of Pharmacy, Arradaza N, The Ohio State University Center
for Biostatistics, Romeo C, The Ohio
State University College of Pharmacy, Email: [email protected]
reduce barriers to immunization rates in
a diverse, multilingual, urban community by identifying perceptions about immunizations and determining barriers to
receiving immunizations.
Methods: Low immunization rates
are a widespread problem. According to
the Centers for Disease Control and Pre-
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vention, grave disparities exist for both
influenza and non-influenza immunizations. Higher socioeconomic status and
being born in the United States correlate with increased immunization rates.
There also are racial disparities; specifically, immunization against influenza
is consistently lower for non-Hispanic
blacks and Hispanics compared with
non-Hispanic whites. Previous studies
have addressed perceptions and barriers to specific vaccines within focused
age groups. This institutional review
board–approved study involves paper
surveys to assess perceptions and barriers regarding immunizations for all
adult immunizations and patients >18
years of age in a multilingual, urban setting. Surveys are conducted in 4 urban
federally qualified health centers and 4
grocery stores with 340B pharmacy affiliations with those clinics. Patients are
invited to complete the survey in English or their native language of Spanish
or Somali by trained surveyors. Surveys
gather demographic data, self-reported
receipt of immunizations, knowledge
about indications for immunizations,
knowledge about access to immunizations, and perceptions of immunization
safety and effectiveness. The data will be
analyzed using descriptive statistics.
Results: Research in progress. Reported results will include aggregate
survey responses addressing study objectives.
Conclusion: Survey results will
guide education and programming
aimed at removing barriers and improving immunization rates in this urban community and others like it in the
United States. This study may generate
the need for future studies to address individual immunization barriers.
120—THE PHARMACIST’S ROLE IN
WORKSITE IMMUNIZATION SERVICES: ASSESSING KNOWLEDGE,
PERCEPTIONS, AND BARRIERS IN
PHARMACIST-DELIVERED WORKSITE VACCINATIONS. New M, University of Kentucky College of Pharmacy, Grise W, Hudspeth B, Kroger Pharmacy, Divine H, University of Kentucky
College of Pharmacy, E-mail: meghann.
[email protected]
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APhA2014 ABSTRACTS
Objective: Currently, pharmacists at
the supermarket chain pharmacy deliver
company employee health and wellness
services and annual influenza vaccines
at the employees’ worksite. Protocols
for immunization delivery now include
10 different vaccinations, which could
be offered and provided by pharmacists
to employees during routine visits at the
worksite. Worksite influenza immunization delivery services have been previously reported in the literature; however,
descriptions of other adult immunization delivery services at the worksite
are lacking. The objectives of this study
are to: (1) assess vaccination knowledge
in worksite employees receiving pharmacist-delivered health and wellness
services; (2) evaluate patient perceptions
of the pharmacist’s role in delivering
worksite vaccinations; and (3) identify
perceived barriers to vaccine delivery at
the worksite.
Methods: Approximately 150 employees at the supermarket chain dairy
who have current insurance coverage
for pharmacy services were selected to
participate. Surveys and a cover letter
approved by the university’s institutional review board will be distributed
to employees at the worksite by pharmacists. Employees will complete the survey anonymously and return to a secure
centrally located drop box to maintain
anonymity. Employees will be asked
to complete the survey within 4 weeks
and will be reminded weekly of survey
completion during employee meetings.
The survey will be developed to collect
demographic information, knowledge
of current recommended adult vaccinations, perceptions of the pharmacist’s
role in immunization delivery, and perceived barriers to worksite immunization services. Results will be analyzed
using descriptive statistics.
Results: Research in progress. Results will be used to design and implement a comprehensive adult immunization delivery service.
Q 121—PHARMACY STUDENTS’
CONFIDENCE WITH AND ATTITUDES ABOUT VACCINE ADMINISTRATION. Allen S, Martin M, Goliak
K, University of Illinois at Chicago Col-
e120 JAPhA | 5 4:2 | M AR/AP R 2014
lege of Pharmacy, E-mail: sallen7@uic.
edu
Objective: The University of Illinois
at Chicago College of Pharmacy requires
all third-year students to participate in
an immunization training program as
part of the curriculum. The purpose of
this study was to assess student pharmacists’ confidence level with and attitudes
about vaccine administration after training.
Methods: A 31-item anonymous
and voluntary survey was administered
to the class of 2012 at mandatory class
meetings during their last year of school.
The research was approved by the institutional review board. Descriptive statistics were used to analyze the survey data.
Results: One hundred sixty surveys
were administered with a response rate
>85%. Survey results show that 6% of
the students had administered >40 intramuscular injections 2 months after training compared with 44% after the completion of their advanced pharmacy practice
experience (APPE) rotations. The number of students who were confident or
extremely confident in administering
intramuscular injections increased from
59% 2 months after training to 90% at the
completion of their APPEs. Eighty-five
percent of the students agree or strongly
agree to being comfortable administering vaccines to patients 2 months after
training, whereas 98% report being comfortable after the completion of APPE
rotations.
Conclusion: Overall, results showed
an increase in confidence and comfort
with vaccine administration based on the
number of vaccines administered. This
study led to the question of whether the
curriculum should require students to
administer a specific number of vaccines
above current training requirements
prior to graduation to aid in the development of confidence and comfort with
vaccine administration.
Original Citation: Allen S, Martin M, Goliak K. “Pharmacy Students’
Confidence with and Attitudes about
Vaccine Administration,” presented at
the AACP Annual Meeting: Chicago, Illinois. Poster Presentation.
122—A
PILOT
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EXPLORATION
STUDY TO IMPLEMENT MOTIVATIONAL INTERVIEWING IN THE
COMMUNITY PHARMACY TO INCREASE ADULT IMMUNIZATION
RATES. Brackett A, Mercer University,
Chapman L, Kroger Pharmacy, Butler M,
Mercer University, E-mail: butler_mb@
mercer.edu
is to evaluate whether the use of motivational interviewing in community
pharmacy could improve immunization
rates with shingles, hepatitis B, hepatitis
A/B combination, pneumonia, and tetanus/diphtheria/pertussis combination
(Tdap) vaccines.
Methods: This institutional review
board–approved study will be conducted at 2 locations of a community
pharmacy chain in Georgia. One location will be the experimental arm and the
other will be the control arm of the study.
Both pharmacies have similar patient
demographics and have immunization
brochures available in waiting areas.
The control pharmacy will use no special
technique to discuss immunizations. The
pharmacy serving as the experimental
arm will use motivational interviewing
with patients for the shingles, hepatitis
B, hepatitis A/B combination, pneumonia, and Tdap immunizations. Pharmacy
staff in the experimental arm will receive
training on motivational interviewing
and will be provided with informational
pocket cards. Patients will be identified
by disease states, age, and other characteristics that make them candidates to receive the immunizations being assessed.
The staff will assess the patient’s immunization status and guide a conversation
to determine whether the patient is ready
to receive immunization(s) they are lacking. If a patient is not ready to receive
the immunization(s) he or she lacks, the
pharmacy staff will follow-up by letter
or phone. If the patient is ready to receive
the immunization(s) he or she lacks, the
patient’s primary care physician will be
contacted to request a prescription for
the immunization(s). The pharmacist
will record all motivational interviewing
encounters on a data collection form.
Results: Data collection begins October 2013.
Conclusion: Research in progress.
APhA2014 ABSTRACTS
This study is expected to show the integral role pharmacists can play in improving immunization rates by introducing a
different technique to discuss immunizations.
123—A RETROSPECTIVE STUDY
OF PHARMACIST-RECOMMENDED VACCINATIONS DURING COMPREHENSIVE MEDICATION REVIEWS. Berkemeyer T, Fisher C, Kroger
Co., E-mail: [email protected]
study are to: (1) determine pharmacist
impact on preventive health, specifically immunization rates during comprehensive medication reviews (CMRs)
with patients, and (2) explore patients’
response to pharmacist-recommended
vaccinations during CMRs.
Methods: A retrospective profile review encompassing claims over 2 years
will be conducted for each patient who
is identified by the pharmacist during a
CMR as needing an immunization. The
immunizations to be evaluated are influenza; pneumococcal; herpes zoster;
and tetanus, diphtheria, and pertussis (Tdap). The percent of vaccines administered will be calculated from the
total number of vaccines that were recommended to patients during CMRs.
Patients’ prescription profiles will be
reviewed for 3 months past the CMR
to identify the vaccines that were given
shortly after the pharmacist recommendation. Additionally, the number of vaccinations declined will be evaluated from
this percent. Secondarily, the responsiveness to the individual vaccinations recommended by the pharmacist during
the CMR will be evaluated by calculating
the percent of patient acceptance for each
vaccination.
124—A STUDENT-LED INITIATIVE
TO IMMUNIZE PHARMACY AND
MEDICAL STUDENTS AGAINST
THE INFLUENZA VIRUS. Arvay B,
Bachmann D, Krinsky D, Ulbrich T,
Northeast Ohio Medical University, Email: [email protected]
is to describe a student-led initiative to
immunize pharmacy and medical stu-
dents against the influenza virus.
Methods: In an effort to promote
interprofessional collaboration, increase
student access to the influenza vaccine,
and provide student pharmacists with
experience providing vaccines, student
pharmacists were given the opportunity
to provide the influenza vaccine to their
medical and pharmacy colleagues starting in 2011 when the university began
requiring all students to receive the vaccine prior to attending rotations. To provide vaccines, student pharmacists are
required to complete the American Pharmacists Association immunization certificate training program and be up to date
with their basic life support training. The
clinics were 1 hour and 30 minutes long,
available for students only, scheduled
within a 1-week time frame in September
and were scheduled outside class times
in the evening and at lunch. Marketing
and sign-ups were completed via e-mail
by the coordinator of student health records. The university partnered with a
local pharmacy to obtain the vaccine. The
cost was $20 with students contributing
$12 and the university contributing $8.
Two pharmacy practice faculty members
who are certified to provide immunizations precepted the clinics.
Results: In September 2013, 3 oncampus immunization clinics were
completed. Thirty student pharmacists
administered 388 influenza vaccinations;
this included 284 vaccines for medical
students and 104 for pharmacy students.
Fifty-three percent (284/534) of all medical students and 39% (104/267) of all
pharmacy students were vaccinated.
Conclusion: Offering a student-run
immunization clinic provides student
pharmacists with a chance to gain confidence in providing immunizations. It
also provides an opportunity for medical
students to observe first-hand the evolving scope of practice of pharmacists.
Further study in this area is needed to
measure student confidence and obtain
medical student feedback.
125—SURVEY TO DETERMINE
TRAVEL MEDICINE AND IMMUNIZATION CONTENT IN PHARMACY
SCHOOL CURRICULA. Dang R, Goad
J, University of Southern California, Hess
j apha.org
K, Western University of Health Sciences, Zeind C, Machado M, Massachusetts
College of Pharmacy and Health Sciences University, Luo S, Law A, Western
University of Health Sciences, E-mail:
[email protected]
Objective: This study aims to: (1) describe the extent to which travel medicine
and immunization content is integrated
into U.S. pharmacy school curricula; and
(2) determine whether there is a correlation between states that allow all travel
vaccines to be administered by pharmacists versus those that do not with regard
to curricular integration.
Methods: Travel medicine is focused
on the health of travelers and involves
patient education, vaccination, and
medication provision. It is well documented in the literature that travelers
often do not seek travel medicine providers before departure, likely due to lack of
awareness of risk or lack of enough providers, resulting in significant morbidity
and mortality. The International Society
of Travel Medicine endorses a multi-specialty approach to the provision of travel
medicine and has established the body
of knowledge as a basis for educational
curriculum development. This study is
a web-based cross-section survey of faculty and administrators at U.S. schools of
pharmacy to be administered during November and December 2013. Elements
of the survey will include respondent
familiarity with travel medicine and immunizations; where and to what extent
travel medicine and immunization content exists within the curriculum; and the
role of the respondent at their institution.
Data will be analyzed using descriptive
and inferential statistics.
Law and Regulations
126—ANALYSIS OF THE EFFECTIVE PATENT LIFE OF NEW PHARMACEUTICALS APPROVED BY
THE U.S. FOOD AND DRUG ADMINISTRATION IN THE PERIOD
1985–2012. Bin Sawad A, Alshahrani
A, Seoane-Vazquez E, Massachusetts
College of Pharmacy and Health Sciences University, Rodriguez-Monguio
R, University of Massachusetts, E-mail:
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APhA2014 ABSTRACTS
[email protected]
Objective: This study assessed the
patent life of new molecular entities
(NMEs) and new biologics (NBs) that
had a patent extension in the period
1985–2012.
the U.S. Food and Drug Administration (FDA), the U.S. Patent and Trademark Office (USPTO), and the U.S. Federal Register websites for all new drugs
approved by the FDA in the period
1985–2012. Descriptive analysis was performed for all variables.
Results: The USPTO listed 499
NMEs/NBs with patent extensions,
representing 51.9% of NMEs/NBs approved in the study period. Complete
drug regulatory and patent information was available for 283 pharmaceuticals. The average patent extension was
2.72 ± 1.39 years. The patent extension
was longest for drugs in the Anatomical Therapeutic Chemical (ATC) classes
alimentary tract and metabolism (3.36
± 1.39 years), systemic hormonal preparations, excluding sex hormones and
insulins (3.03 ± 1.48 years), and nervous
system (3.03 ± 1.53 years). The shortest
patent extensions were granted to antiinfectives for systemic use (2.47 ± 1.22
years), sensory organs (2.47 ± 1.09 years),
and musculoskeletal system (2.34 ± 1.32
years). The average duration of the clinical trial period was 5.52 ± 3.41 years. The
longest clinical trial periods corresponded to musculoskeletal system (8.45 ± 5.38
years) and the shortest was for sensory
organs (4.31 ± 1.77 years). The average
FDA review time was 1.65 ± 1.31 years; it
was highest for respiratory system (3.22
± 2.34 years) and lowest for systemic hormonal preparations (0.98 ± 0.56 years).
The overall effective patent life without
patent extensions was 8.70 ± 7.01 years,
whereas the effective patent life with patent extensions increased to 11.71 ± 6.78
years. The longest effective patent life
corresponded to dermatologicals (13.59
± 1.03 years); and the shortest patent life
corresponded to cardiovascular agents
(6.56 ± 23.21 years).
Conclusion: There were significant
differences in the clinical trial periods,
FDA review time, and effective patent
life among the different ATC classes of
e122 JAPhA | 5 4:2 | M AR/AP R 2014
new NMEs/NBs approved by the FDA
in the study period.
127—ASSESSING DIFFERENCES IN
THE CHARACTERISTICS OF THE
NEW PHARMACEUTICALS APPROVED BY THE FOOD AND DRUG
ADMINISTRATION AND THE EUROPEAN MEDICINES AGENCY.
Badawoud E, Alshehri N, Alqahtani S,
Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences
University, Rodriguez-Monguio R, University of Massachusetts, E-mail: [email protected]
Objective: This study aims to explore some areas of discrepancies between the Food and Drug Administration (FDA) and the European Medicines
Agency (EMA) in approving new molecular entities (NME) and new therapeutic
biologics (BLA) in the period from 1999
to 2011.
Methods: FDA and EMA websites
were utilized to retrieve data regarding
drug applications, approvals, orphan
status, and indications for new NMEs
and BLAs. The 2 systems were compared
using descriptive statistics and a t test
was applied to assess differences in averages. Significant level was set at 0.05.
Results: Both regulatory agencies
approved a total of 101 drugs (82 NME
and 19 BLA; all were FDA priority reviews). BLAs were submitted 1.25 ± 4.18
months later (median 0.33 months) and
approved 7.14 ± 5.47 months later (median 5.75 months) by EMA compared with
FDA. NMEs were submitted to EMA
1.44 ± 24.52 months later (median 0.44
months) and approved by FDA 6.67 ±
23.43 months later (median 7.49 months)
than EMA. The BLA average review
time was statistically significantly lower
(P<0.001) for FDA 7.67 ± 2.24 months
(median 6.21 months) than EMA 14.6 ±
3.33 (median 14 months). The NME average review time was statistically significantly lower (P<0.001) for FDA 9.25
± 9.10 months (median 5.98 months)
than for EMA 14.48 ± 4.09 (median 13.72
months). The number of products with
orphan designation was lower in EMA
(n = 33) than in FDA (n = 57). EMA granted orphan designation to 2 products that
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United States. The United States granted
orphan designation to 13 products that
European Union. Differences in the indications approved in both systems were
observed in 24.8% (n = 25) of the drugs.
Conclusion: Significant differences
exist in the time elapsed between the filing and the approval of drugs as well as
in orphan designation. Harmonization
of the regulatory systems could facilitate
timely approval of essential pharmaceuticals.
128—COMMUNITY
PHARMACISTS’ ATTITUDES TOWARD AN
EXPANDED CLASS OF NONPRESCRIPTION DRUGS. Shah R, Holmes
E, West-Strum D, University of Mississippi School of Pharmacy, Patel A, Medical Marketing Economics, E-mail: [email protected]
class of drugs which would not require
a prescription, but would require a pharmacist’s consultation upon purchase.
nonprescription drug class termed as
the “new paradigm” using innovative
technologies. The objectives of this study
were to: (1) measure community pharmacists’ attitudes toward the new paradigm; and (2) determine whether these
attitudes differed according to practice
was conducted using a self-report, webbased survey administered to a national
survey items were developed based
on existing scales in the literature and
the FDA’s proposed guidelines for the
new paradigm. A principal components
analysis (PCA) with VARIMAX rotation
and reliability analyses were conducted
to identify the factors affecting community pharmacists’ attitudes toward the
new paradigm. Descriptive statistics
were used to describe pharmacists’ attitudes. Multivariate Analysis of Variance (MANOVA) was used to determine
whether attitudes toward the new paradigm differed based on practice and de-
APhA2014 ABSTRACTS
mographic characteristics.
Results: Completed responses were
obtained from 462 respondents. PCA
results suggested that respondents’ attitudes toward the new paradigm is
composed of 6 factors including: patient
care, workflow, patient safety, impact on
non-pharmacist providers, pharmacist
burden, and access. Respondents were
generally positive about the provision of
patient care under the new paradigm but
were skeptical about workflow change,
professional liability, increased workload, and reimbursement. Respondent
attitudes differed based on certain practice and demographic variables.
Conclusion: Respondents were
positive about many respects of the new
paradigm, but still hesitant about others. Arguably, community pharmacists
are the most important stakeholders for
expanding the current nonprescription
drug class and future input should be
obtained from them; their input will be
critical to the FDA’s decision about the
new paradigm.
129—COMMUNITY
PHARMACISTS’ CLASSIFICATION OF PRESCRIPTION DRUGS INTO DISPENSING CATEGORIES UNDER
THE FOOD AND DRUG ADMINISTRATION’S PROPOSED NEW PARADIGM. Shah R, Holmes E, West-Strum
D, University of Mississippi School of
Pharmacy, Patel A, Medical Marketing
Economics, E-mail: [email protected].
edu
class of drugs that would not require a
prescription, but would require a pharmacist’s consultation upon purchase.
nonprescription drug class termed the
“new paradigm” using innovative technologies. The objective of this study was
to determine which drugs community
pharmacists believe are acceptable additions to an expanded definition of
nonprescription drugs under the new
paradigm.
was conducted using a self-report, web-
based survey administered to a national
survey contained a list of 24 current
prescription-only drugs that may be potential candidates for the new paradigm,
based on criteria outlined by the FDA,
and questions related to respondent demographic and practice characteristics.
The list of drugs was developed using
relevant literature and content experts.
Respondents were asked to indicate
whether a particular drug should be
marketed as a prescription drug, nonprescription drug, or as a drug under the
new paradigm (i.e., expanded nonprescription drug class).
Results: Investigators received 462
completed surveys. If the new paradigm
drug class were implemented, the majority of respondents indicated that clopidogrel (Plavix) and zolpidem (Ambien)
should still be dispensed as prescription
drugs. Atorvastatin (Lipitor), metformin (Glucophage), sildenafil (Viagra),
montelukast (Singulair), finasteride
(Propecia), promethazine (Phenergan),
and oseltamivir (Tamiflu) among others
were considered appropriate to be marketed under the expanded nonprescription drug class (i.e., the new paradigm).
Desloratadine (Clarinex) and prenatal
vitamins were considered appropriate
for nonprescription status.
Conclusion: Respondents thought
most drugs on the list provided can be
categorized as drugs in the new paradigm class. If implemented, the new
paradigm has potential to expand pharmacists’ provision of patient care. As the
FDA continues to seek feedback from
stakeholders, pharmacists’ feedback,
especially with regard to which medications should be a part of the new paradigm class of drugs, is critical.
130—THE EFFECT OF HYDROCODONE RESCHEDULING ON
A RETAIL PHARMACY CHAIN’S
DISPENSING PATTERNS IN NEW
YORK STATE. D’Angelo M, CVS Caremark, E-mail: [email protected]
Objective: Prescription drug abuse
is among the most alarming and concerning medication usage trends seen in
the past decade. Rates of abuse increase
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each year, and as a result the health care
industry has been tasked with mitigating
this national crisis. Controlled medications, especially opioids, are the most
widely abused drugs in the country, and
many regulations are being explored to
decrease these behaviors. The state of
New York rescheduled hydrocodone
products from schedule III to schedule
II on February 23, 2013, to more closely
regulate the prescribing and dispensing of these medications. The effects of
rescheduling one of the most frequently
dispensed medications in the country
need to be explored, and this research
will seek to determine this regulation’s
impact on hydrocodone product dispensing, prescribing, and patient utilization.
Methods: CVS Pharmacy’s dispensing data from New York state will be
compared between March–August 2012
and March–August 2013 for hydrocodone product tablets. Parameters studied
will include hydrocodone product prescription count, quantity filled per prescription, filling habits of chronic users,
and abuse trends. Script and quantity data for New York will be compared with a
state with similar hydrocodone dispensing habits in 2012. Chronic users will be
identified in 2012 data, and their use of
hydrocodone products in 2012 will be
compared with 2013 use. This population’s filling data from 2013 also will be
analyzed to find any shifts in prescribing
patterns. An algorithm will be used to
identify abuse patterns before and after
rescheduling.
131—THE EFFORT FOR PHARMACIST PROVIDER STATUS: A SURVEY OF STATE PHARMACY ASSOCIATIONS. Brown P, University of
School of Pharmacy, Branham A, Moose
Pharmacy, Holland W, University of
School of Pharmacy, Dalton E, Moose J,
Moose Pharmacy, Ferreri S, Marciniak
M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy,
E-mail: patrickbrown@moosepharmacy.
com
Objective: The issue of obtaining
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APhA2014 ABSTRACTS
provider status for pharmacists has been
gaining momentum within the profession. National pharmacy associations
have issued statements regarding this effort, but little has been published about
efforts at the state level. The aims of this
study are to: (1) evaluate the current efforts of state pharmacy associations in
regard to obtaining pharmacist health
care provider status; and (2) determine
which state association efforts align with
each other and with national pharmacy
associations.
will be conducted via Qualtrics. Utilizing
contact information provided by the National Alliance of State Pharmacy Associations (NASPA), an e-mail with a survey
link will be sent to the executive director
of each pharmacy association in the 50
states, District of Columbia, and Puerto
Rico. Participants will be asked if their
state association has passed an official
resolution to support the effort for provider status, if there is any state-specific
legislation pending related to provider
status, what resources have been developed to support advocacy, what barriers
have been encountered, and if their state
association has any additional plans related to advancing provider status. The
10-item questionnaire will be pilot tested
among a convenience sample of pharmacists for feedback on validity and question structure. The survey will remain
open for 30 days and nonresponders will
receive an e-mail reminder 3 weeks after
the initial message. A follow-up telephone call may be conducted to clarify
answers or prompt nonresponders. Descriptive statistics will be used to analyze
survey responses.
Results: Research in progress. Institutional review board approval is anticipated in October 2013. The survey will
be distributed in November 2013 with
data analysis conducted from December
2013 to February 2014. Upon completion,
results will be distributed to state and national pharmacy associations to serve as
an information source for those working
toward provider status.
132—HOW
DOES
THE
CONTROLLED SALE OF ANTIBIOTICS
INFLUENCE THE BACTERIAL RE-
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SISTANCE IN BRAZIL?. Mattos K,
Levy C, Ambrosio R, Mazzola P, Moriel
P, Faculty of Medical Sciences, Unicamp,
Objective: In Brazil, as a consequence of the irrational use of antibiotics, resolution number 20/2011 was
implemented to control the sale of antibiotics. The current study is designed to
outline the profile of bacterial resistance
in source communities in patients with
urinary tract infection (UTI), before and
after the legislation.
Methods: Data collection (1 year
before and 1–2 years after implementation of the resolution) with respect to
bacterial resistance was accomplished
by employing a computer system that
analyzed all urine cultures diagnosed
with UTI, as requested during the study
periods in the emergency department of
a university hospital.
Results: Of the 361 cases of UTI that
were detected over a 3-month period,
urine cultures were asked in 23% cases.
Ciprofloxacin and norfloxacin were the
most prescribed antibiotics. Among the
597 cases studied during the period before the legislation (73% women), 352
(59%) were resistant to at least 1 group of
antimicrobials analyzed. In the next year
after the legislation was implemented,
of the 919 patients tested (84% women),
524 (57%) were resistant to at least 1
group of antimicrobials analyzed. In
the subsequent year, of the 855 patients
(86% women), 493 (58%) were resistant
to at least 1 group of antibiotics. Overall, among all studied cases, the highest
resistance was observed for ampicillin,
followed by trimethoprim-sulfamethoxazole, and ciprofloxacin, although ciprofloxacin is the first choice for the treatment of UTI. Escherichia coli is the most
frequent etiological agent found.
Conclusion: In the first year, a minor
drop in the percentage of bacterial resistance was observed, but in the second
year a significant increase was noticed.
Based on these studies so far, we cannot
confirm that the result is a direct reflection of the resolution because several
additional factors can influence these indices. Therefore, continued study of the
indices is planned.
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133—IMPACT OF THE QUALITY
INDICATOR SURVEY NURSING
HOME SURVEY PROCESS ON
PROVIDER RESPONSE TO THE
CMS PARTNERSHIP TO IMPROVE
DEMENTIA CARE IN NURSING
HOMES INITIATIVE. Urick B, Carnahan R, Kaskie B, University of Iowa, Email: [email protected]
study is to determine the association between the Quality Indicator Survey (QIS)
process for surveying long-term care facilities and nursing home providers’ response to the Centers for Medicare and
Medicaid Services (CMS) Partnership
to Improve Dementia Care in Nursing
Homes initiative (Partnership initiative).
Methods: Data for this project came
from a survey of nursing home surveyors conducted by the Center for Medicare Advocacy. The survey’s goal was
to obtain nursing home surveyors’ attitudes, beliefs, and experiences regarding
the antipsychotic use citation process.
Ten purposefully selected, nationally
representative states were included in
the study sample. Three states used the
QIS process and 7 used the Standard survey process. Surveys were sent to each
nursing home surveyor in every state in
the study sample. Descriptive statistics,
chi-square, and logistic regression were
used in this study.
Results: The initial response
rate was 90.5% (597/660) with 48.5%
(320/660) respondents completing the
entire survey. Response rates by demographic variables were only different for
surveyors in QIS survey states compared
with Standard survey states. The majority of nursing home surveyors reported
that they had seen positive provider
responses to the Partnership initiative.
While fewer surveyors reported seeing
questionable provider responses, 21.6%
reported they observed falsification of
records and 39.1% reported they had
seen providers creating a new, but false,
diagnosis of psychosis as a response to
the Partnership initiative. Logistic regression models comparing QIS to Standard survey states controlling for surveyor demographic variables found that
surveyors in QIS states reported more
positive provider responses and fewer
APhA2014 ABSTRACTS
negative responses to the initiative.
Conclusion: This study finds the
QIS survey process may have beneficial
influences on providers responding to
the CMS Partnership initiative and has
implications to other initiatives to reduce
inappropriate antipsychotic use in nursing homes.
134—ORPHAN DRUG DESIGNATIONS AND APPROVALS BY THE
U.S. FOOD AND DRUG ADMINISTRATION AND THE EUROPEAN
MEDICINES AGENCY. Alghamdi
A, Almutairi R, Felemban D, SeoaneVazquez E, Massachusetts College of
Pharmacy and Health Sciences, Rodriguez-Monguio R, University of Massachusetts–Amherst, Szeinbach S, The
Ohio State University, E-mail: enrique.
[email protected]
Objective: The United States and the
European Union implemented regulations for encouraging the development
of drugs for rare diseases. This study
examined the characteristics of orphan
drugs (OD) designated and approved
by the U.S. Food and Drug Administration (FDA) and the European Medicines
Agency (EMA) from August 2000 to September 2012.
Methods: Data for orphan designations and approvals were extracted from
the FDA and EMA online databases. Restrictiveness (i.e., limitations in patient
population and scope of the indications)
of OD designated by each regulatory
agency was assessed. Descriptive statistics were performed.
Results: A total of 2,802 OD were
granted by both agencies in the study period. Overall, 41.6% (n = 1,166) of the designations were designated only by the
FDA, 17.6% (n = 492) were designated
only by the EMA, and 40.8% (n = 1,144)
by both agencies. The FDA designated
the orphan indications before August
2000 in 101 of the orphan indications designated by EMA. In the study period, the
FDA and EMA approved a total of 179
and 88 orphan indications, respectively;
50 indications were approved by both
agencies. Products designated by both
agencies had larger approval rate (13.7%
of the designated indications) than products designated only by the FDA (7.9%)
or designated by the EMA (3.7%). The
indications designated by both agencies
(n = 572 indications in each agency) were
the same in 79.5% of the designations;
16.3% were more restrictive in the FDA,
and 4.2% were more restrictive in the
EMA.
Conclusion: The European Union
had more restrictive criteria for orphan
designation, fewer orphan designations,
and fewer product approvals than the
United States. Orphan indications were
more restrictive in the FDA than in EMA.
Harmonization of the OD regulatory
processes of FDA and EMA could result
in improved access to OD in the United
States and the European Union.
135—PEDIATRIC SYSTEMIC ANTIBIOTIC DRUG APPROVALS IN THE
UNITED STATES: ASSESSING THE
IMPACT OF THE BEST PHARMACEUTICALS FOR CHILDREN ACT
AND THE PEDIATRIC RESEARCH
EQUITY ACT. Lindberg-Springs S, Seoane-Vazquez E, Massachusetts College
of Pharmacy and Health Sciences University, Rodriguez-Monguio R, University of Massachusetts, E-mail: enrique.
[email protected]
Objective: This study examined
the extent to which public policies and
economic incentives increased pediatric
drug approvals and improved pediatric
drug labeling information for systemic
antibiotics (ABX) marketed in the United States. In 2012, the Food and Drug
Administration (FDA) Safety and Innovation Act made permanent pediatricrelated regulations directed to improve
the safety and effectiveness of drugs
used in children. Specifically, the Best
Pharmaceuticals for Children Act of 2002
provided the regulatory framework for
pediatric exclusivity, incentivizing pediatric research and development (R&D),
and the Pediatric Research Equity Act of
2003 authorized the FDA to require pediatric studies of marketed drugs.
the FDA webpage, Micromedex, and the
American Hospital Formulary Service
websites. Data included ABX generic
name, number of FDA-approved indications, age group for each indication, and
approved orphan indications for each
j apha.org
drug. Descriptive statistics were performed and the pharmaceutical active
ingredient was the unit of analysis.
Results: The study included 87
FDA-approved ABX that were marketed in the United States on September 1,
2013. Overall, 77 ABX (88.5% of the marketed ABX) included ≥1 pediatric indications, 45 (51.7%) did not specify the age
group for pediatric indication, 29 (33.3%)
excluded neonates from the indication,
and 3 (3.4%) were specifically indicated
for use in neonates. Pediatric written
requests were issued to 11 (12.6%) ABX.
Orphan drug designation was granted to
15 (17.2%) ABX, none for pediatric use.
Conclusion: Children, and especially neonates, persist as patient subpopulations that remain understudied
and underserved. Despite the adoption
of more robust regulatory requirements
and economic incentives for pediatric
research, appropriate pediatric labeling
information is still lacking. The small
market size of the pediatric market and
heterogeneity of pediatric patients reduce incentives for private R&D. Pediatric R&D must be driven by further public
regulation, incentives, and financing.
136—THE PERCEPTION OF PROVIDER STATUS: A SURVEY OF
NORTH CAROLINA PHARMACISTS. Holland W, University of North
of Pharmacy, Branham A, Moose Professional Pharmacy, Brown P, University of
School of Pharmacy, Dalton E, Moose J,
Moose Professional Pharmacy, Ferreri S,
Marciniak M, University of North Carolina at Chapel Hill Eshelman School of
Objective: Pharmacists are not currently recognized as patient care providers by the federal government under the
Social Security Act. As a result, pharmacists are underutilized in the health care
team due to barriers such as financial
compensation. A coalition of 14 national pharmacy organizations has begun
working toward provider status since
the beginning of 2013. The objective of
this study is to determine pharmacist understanding of obtaining provider status
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APhA2014 ABSTRACTS
and the perceived implications of how
this would impact pharmacy practice.
will be conducted via Qualtrics. Utilizing contact information provided by the
North Carolina Board of Pharmacy, an
e-mail with a survey link will be sent to
all actively licensed pharmacists. Pharmacists who practice in all settings will
be included; pharmacists without a valid
e-mail address will be excluded.
Survey questions will address pharmacist demographics, practice setting,
current services provided, compensation
for these services, potential impact of
pharmacist-recognized provider status,
and barriers to attaining patient care provider status. The 25-item questionnaire
will be pilot tested using a convenience
sample of pharmacists for feedback on
validity and question structure. The
survey will be open for 30 days and a
reminder e-mail will be sent 2 weeks after the initial message. Participants will
have the option to enter an incentive
drawing to receive a gift card at time of
survey completion. Descriptive statistics
will be used to analyze data collected.
Results: Research in progress. Institutional review board approval is anticipated in October 2013. The survey will be
distributed in November 2013 with data
analysis conducted from December 2013
to February 2014.
137—PHARMACISTS’
KNOWLEDGE OF THE PATIENT PROTECTION AND AFFORDABLE CARE
ACT. Khanna R, Mahabaleshwarkar
R, Holmes E, Jariwala K, University of
Mississippi School of Pharmacy, E-mail:
[email protected]
Objective: The Patient Protection
and Affordable Care Act (PPACA) is the
most comprehensive health care law enacted in the United States since the creation of Medicare and Medicaid in 1960s.
The primary aim of the PPACA is to increase health insurance coverage among
the U.S. population through Medicaid
expansion and insurance exchanges.
Other provisions of the PPACA include
increased funding for medication therapy management services, funding for
interdisciplinary teams involving pharmacists, and phasing out the Medicare
e126 JAPhA | 5 4:2 | M AR/AP R 2014
Part D coverage gap (donut hole). Given
the profound influence of this law on
the pharmacy profession, the purpose
of this study was to assess pharmacists’
knowledge of and attitudes toward the
PPACA.
Methods: Using a cross-sectional
descriptive design, an online survey was
distributed to pharmacists registered in 5
states (i.e., Louisiana, Minnesota, Mississippi, Oregon, and Tennessee) using the
Qualtrics software program. Descriptive
analysis of study items was conducted.
Results: A total of 1,217 usable responses (5.6%) were received. Threefourths of pharmacists agreed that the
American health care system needs to be
reformed. Approximately 36% agreed
that they understood the major provisions of the PPACA. Approximately 22%
of pharmacists agreed that the PPACA
will improve health care quality and
will contain health care costs. Just over
half (approximately 51%) of pharmacists indicated that they did not support
the PPACA, with approximately 48%
supporting the PPACA. Roughly 46%
of pharmacists supported repeal of the
PPACA, roughly 33% did not support
repeal, and 21% were undecided.
Conclusion: Respondent pharmacists were divided in terms of their support and attitudes toward repealing the
most significant health care legislation
passed in the United States in over 4 decades. Given that the minority of respondents indicated understanding major
provisions of the PPACA, professional
pharmacy organizations and other stakeholders may consider providing continuing education and other methods to
educate pharmacists about the PPACA.
Marketing and Management
138—THE EFFECT OF INCORPORATING PHYSICIAN DETAILING
INTO A MARKETING PLAN ON
THE NUMBER OF PRESCRIPTION
COMPOUNDS FILLED AT AN INDEPENDENT PHARMACY. Griggs
C, Virginia Commonwealth University,
Kaefer T, Bremo Pharmacy, Goode J,
ja p h a .org
study are to: (1) evaluate whether implementation of a physician detailing marketing plan that promotes compounding
pharmacy services increases the number of new compounding prescriptions
filled; and (2) compare the effectiveness
of 3 different types of physician detailing
(i.e., written materials, e-mail plus written materials, and face-to-face plus written materials).
Methods: A marketing plan will be
designed including physician detailing.
A list of physicians currently prescribing
compounded medications for an independent pharmacy in Richmond, Virginia, will be generated. Physician practice
sites will be randomized into 3 groups.
The first group will receive educational
materials and no physician detailing.
The second group will receive electronic
physician detailing via e-mail in addition
to educational materials. The third group
will receive face-to-face physician detailing in addition to educational materials.
The number of compounded prescriptions filled will be assessed for 5 months
before and after implementation of the
marketing plan.
139—INCREASING
OVER-THECOUNTER ANALGESIC SALES BY
MEETING CUSTOMER NEEDS IN
AN INDEPENDENT PHARMACY.
Zecchini J, University of Pittsburgh,
Vargo P, Medicap Pharmacy, Smith R,
University of Pittsburgh, E-mail: [email protected]
Objective: This study aims to identify and implement changes in the overthe-counter (OTC) analgesic section to
increase sales based on customer feedback.
Methods: This is a market research
study approved by the university’s institutional review board to determine customer awareness, usage, and satisfaction
with the OTC analgesic section in an independent pharmacy in eastern Pennsylvania. The goal of the study is to increase
OTC sales by modifying service offerings, product presentation, and access
to the pharmacist. In-store surveys were
conducted by store personnel with customers >18 years of age who consented
to the survey. Survey domains included
APhA2014 ABSTRACTS
OTC customer use, product layout and
presentation, pricing, and pharmacist
access. The survey was administered for
a 2-week period. Customer responses
will be tabulated and descriptive statistics used to identify changes that can be
made to the OTC product section layout.
Selected changes will be implemented
and their effectiveness evaluated by
comparing OTC analgesic sales for 3
months prior to the changes with those 3
months after the changes.
Results: Research in progress. Results are pending completion of the
study in November 2013. Effective capture of the customer experience is an
important component of exceeding customer expectations and increasing market share. This study will provide methods that can be easily implemented by
other independent pharmacies. Research
findings will demonstrate whether this
information can be converted to results
such as increased sales.
140—MANAGERIAL SKILLS OF
NEW PRACTITIONER PHARMACISTS
WITHIN
COMMUNITY
PRACTICE. Mospan C, Sweaney A,
Casper K, The Ohio State University College of Pharmacy, E-mail: sweaney.2@
osu.edu
study are to: (1) identify managerial
skills required in community pharmacy
practice; (2) explore new practitioners’
previous exposure to these skills; and (3)
assess new practitioners’ perceived preparedness to take on managerial responsibilities.
Methods: An anonymous, online
survey was developed utilizing Qualtrics. Surveys will be distributed using
e-mail addresses obtained from state
boards of pharmacy for pharmacists
licensed by examination from January
2003 to October 2013. Pharmacists who
currently do not practice within the community setting will be excluded. Participants will have 30 days to complete the
survey, and will be sent weekly reminder e-mails during the data collection period. Descriptive statistics will be used to
report responses. Data will be analyzed
utilizing biostatistician support through
the university.
Results: Research in progress. Because previous literature has focused
on pharmacy management skills within
the health-system setting, the results
of this project will be used to identify
managerial skills required within community pharmacy practice. By assessing
the perceived preparedness of new practitioners to take on managerial roles, continuing education can be developed to
fill knowledge and skill gaps. This information also may be utilized by colleges
of pharmacy for doctor of pharmacy degree curricular assessment and revision.
By identifying and understanding the
required managerial skills of community
practitioners, educators can strive to better prepare new practitioners to take on
managerial roles as part of their current
or future practice.
study that includes approximately 30
women who have seen a practitioner
who uses the OHB system. These women
must have completed an initial questionnaire and serum testing within a
comparable time frame. Additionally, if
a patient has a follow-up questionnaire
and follow-up serum level it would allow further demonstration of the relationship between the two. Using the
practitioner’s login, the questionnaire
and serum results will be de-identified
and placed in an Excel spreadsheet for
analysis. Analysis will help determine
whether there is a relationship between
symptoms and serum levels. This study
will be submitted to the institutional review board for approval.
Maternal, Child, and Women’s
Health
Q 142—CHARACTERISTICS OF
YOUNG WOMEN WHO DEMONSTRATED CORRECT VERSUS INCORRECT USE OF AN EMERGENCY
CONTRACEPTIVE. Cwiak C, Emory
University School of Medicine, Howard
B, Teva Global Medical Affairs, Hsieh J,
Ricciotti N, Teva Branded Pharmaceutical Products, R&D, Inc., E-mail: ccwiak@
emory.edu
study is to examine percentages and
characteristics of young women who
used an emergency contraceptive (EC)
correctly versus incorrectly.
Methods: This was a post hoc analysis of a case-series study assessing the
ability of female patients, aged 11 to 17
years, to correctly use a single-dose 1.5mg levonorgestrel EC under simulated
over-the-counter conditions, without
provider assistance. Correct use was
defined as EC use within 72 hours following unprotected sexual intercourse.
A limited medical history, including allergies, ages at menarche and coitarche,
previous birth control, pregnancy history, and current pregnancy status, was
collected from each participant.
Results: Of the 297 female patients
in the treated population who used the
EC, 263 (88.6%) demonstrated correct
use within 72 hours after unprotected intercourse, and 34 (11.4%) reported incorrect use. Although different age groups
141—ARE HORMONAL SYMPTOMS
A MATCH FOR SERUM LEVELS?.
Chasse A, Moody K, Hrncir J, Las Colinas Pharmacy, E-mail: ashley.n.chasse@
gmail.com
Objective: Community pharmacists assess symptoms to address the efficacy and safety of medications. Once
medication-related problems are ruled
out, the next step is to refer patients to
a health professional who can treat the
patient’s condition. Advising patients is
easier when the symptoms they exhibit
indicate a specific serum or clinical level.
Optimum Hormone Balance (OHB) is a
pharmacist-created clinical decision support system used to advance the practice
of balanced bio-identical hormone and
thyroid therapy through a collaborative
approach. Practitioners use OHB to email a comprehensive symptoms questionnaire to their patients, input serum
levels, and track changes. In addition, a
practitioner has the opportunity to use
the system to request a consult with the
bio-identical hormone replacement therapy pharmacists. Using OHB, this study
will assess the correlation of symptoms
associated with hypothyroidism, hyperthyroidism, low estrogen, low progesterone, and low testosterone provided with
their respective serum levels.
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APhA2014 ABSTRACTS
reported correct use ranging from 80.6%
in the 11- to 14-year-old subgroup to
94.6% in 17-year-old participants, average ages for correct and incorrect users
were similar (15.7 and 15.5 years, respectively), as were average ages at menarche
(11.9 and 12.1 years, respectively) and
coitarche (14.6 and 14.3 years, respectively). Reproductive histories were similar
between the groups, with the majority of
patients reporting never being pregnant
(88.2% for correct use and 85.3% for incorrect use), never giving birth (97.0%
and 97.1%, respectively), and never having an abortion (92.0% and 91.2%, respectively). Birth control histories also were
similar for correct users (64.3% used
condoms, 32.7% used oral contraception,
and 27.8% never used birth control) and
incorrect users (52.9%, 23.5%, and 35.5%,
respectively).
Conclusion: There were no major
differences between young women who
used the EC correctly versus incorrect users. Most participants could correctly use
the EC, regardless of age, demonstrating
a high degree of understanding of the
product labeling in individuals aged ≤17
years. Further studies are needed to understand and address incorrect EC use in
this population.
Original Citation: Cwiak C, Howard B, Hsieh J, Ricciotti N. Characteristics
of young women who demonstrated correct versus incorrect use of emergency
contraception. Presented at Society of
Family Planning. October 6-7, 2013. Contraception. September 2013: 88(3):471.
Q 143—ECONOMIC ANALYSIS OF A
PRIMARY CARE CLINICAL PHARMACY SERVICE ON POST-FRACTURE CARE IN POSTMENOPAUSAL WOMEN. Irwin A, Oregon State
University, Heilmann R, Billups S, Kaiser
Permanente Colorado, E-mail: adriane.
[email protected]
Objective: A previously completed
study of women aged ≥67 years with
a documented fracture showed that a
Clinical Pharmacy Osteoporosis Management Service (CPOMS) was associated with a significantly greater proportion of women completing bone mineral
density (BMD) testing or initiating drug
therapy when compared with a similar
e128 JAPhA | 5 4:2 | M AR/AP R 2014
intervention provided by a nurse (65%
vs. 46%, respectively; P< 0.001). The purpose of this study was to compare the
cost inputs associated with each intervention and quantify any cost avoidance
due to hip fracture prevention.
Methods: This economic analysis
was conducted from the health care
payer’s perspective. Intervention costs
included health care provider time,
anti-osteoporosis medications, and
BMD tests. Data from the original study
was used to construct a deterministic
decision-tree analysis model to compare
12-month costs that included predicted
hip fractures.
Results: There were 827 women
managed by CPOMS and 302 women
in the comparator group in the original study. The cost of provider time for
CPOMS and comparator group interventions was $27.16 and $24.03 per patient
evaluated, respectively. However, for
those patients achieving the endpoint
of completing BMD testing or initiating
drug therapy, the cost was $100.75 and
$138.19 per patient, respectively. Based
on the decision-tree analysis model,
the 1-year cost of osteoporosis care for
CPOMS patients was $413,753.05 versus
$506,701.21 for patients in the comparator service.
Conclusion: The CPOMS resulted in
a higher cost per patient evaluated, but a
lower cost for patients completing BMD
testing or initiating drug therapy. When
including costs associated with predicted hip fractures, CPOMS was less expensive than the comparator group because
more patients completed treatment
recommendations. From the health care
payer’s perspective, the CPOMS intervention appears to have a lower cost per
patient achieving treatment outcomes
while also leading to future cost savings.
Original Citation: Irwin AN, Heilmann RMF, Billups SJ. Economic analysis of a primary care clinical pharmacy
service on post-fracture care in postmenopausal women. American College
of Clinical Pharmacy (ACCP) Annual
Meeting; Albuquerque, NM, October
13–16, 2013. (poster)
Q 144—INNOVATIVE METHOD TO
PROVIDE BEDSIDE MEDICATION
ja p h a .org
DISCHARGE COUNSELING IN A
RESOURCE-CONSTRAINED ENVIRONMENT: MEDICATION INFORMATION FOR NURSING MOTHERS VIDEO. Hellwig H, Gunter J, Fort
Belvoir Community Hospital, E-mail:
[email protected]
Objective: The objective of this presentation is to describe the creation of
a video that provides medication discharge counseling to patients admitted
to the hospital’s Mother-Baby Unit.
Methods: As part of a pharmacy discharge process improvement initiative, a
multidisciplinary team of pharmacists,
pharmacy technicians, nurses, and physicians determined that a gap existed in
the provision of bedside discharge counseling to new mothers on the hospital’s
Mother-Baby Unit. The team identified
that an opportunity existed in the creation of a video that would provide discharge counseling and education about
taking medications while lactating. Several factors led the team to its decision to
create a video for this patient population.
First, pharmacy staffing levels could not
support bedside discharge counseling in
this lower risk population. Next, the vast
majority of patients received the same
medications upon discharge. Finally, the
facility has several other videos that are
required for different patient populations to watch before discharge; therefore, this new video would integrate well
into existing processes and technology.
A multidisciplinary team wrote and developed the script for the movie, which
was then reviewed by Public Affairs before submission to the Visual Information Directorate, Bureau of Medicine and
Surgery, for production.
Results: A 6-minute video was created using both narration and actors.
Shots include pharmacy and nursing
staff members and a mother taking medications and breastfeeding her baby. This
video is part of the mandatory viewing
list for mothers before discharge and it
will be viewed by more than 1,500 patients annually.
Conclusion: Use of technology is
an important asset to meet patient care
needs during the current resource-constrained environment within Department of Defense health care. Creation of
APhA2014 ABSTRACTS
an educational video was ideal for this
low-risk, homogeneous population. Use
in other populations should be explored.
Original Citation: Hellwig H, Gunter A. Innovative Method to Provide Bedside Medication Discharge Counseling
in a Resource-constrained Environment:
Medication Information for Nursing
Mothers Video. JAPhA 2013; 53:e151170.
Medication Reconciliation
145—EVALUATING PHARMACISTDELIVERED
TRANSITION
OF
CARE DISCHARGE SERVICES IN
REDUCING HOSPITAL READMISSION RATES. Panofsky L, University
of the Pacific, E-mail: linda.panofsky@
gmail.com
was to analyze whether pharmacist-delivered medication review and bedside
consultation significantly reduced samecause 30-day hospital readmission rates.
Methods: This was a prospective study enrolling internal medicine
patients discharging to home at high
risk for readmission (e.g., heart failure [HF], pneumonia, diabetes). Over
the 11-month study period (beginning
September 2012), medication reconciliation and bedside consultation were
provided to 607 patients. Additionally,
medications were provided at bedside
for patients eligible for copay waiver
programs. All patients were to receive
a 72-hour follow-up phone call with a
pharmacist. Readmission rates were
calculated based on diagnosis, primary
language, homeless status, whether the
patient received medications at bedside,
or if successful follow-up was made with
patient.
Results: The hospital’s baseline 30day same-diagnosis readmission rate
for all causes was 14.6%. Participant demographics were 11% homeless, 78%
English speaking, 16% Spanish speaking,
60% male, 28% Medicaid, 16% Medicare,
and 18% no insurance. Only 36% of patients were able to be reached for followup call and 76% received medications at
bedside. Total readmission rate for all
study participants was 10.21%, which
equates to 1 readmission prevented for
every 23 patients. Readmission rates by
characteristics were: 14.92% homeless
versus 9.63% non-homeless; 11.42% English speaking versus 5.97% non-English
speaking; 7.4% follow-up completed
versus 11.8% no follow-up; and 9.9%
for received medications at bedside versus 11.3% no medications at bedside.
Highest readmission rate (31%) was for
patients with liver disorder (including
alcoholic cirrhosis). Readmission rate for
patients with HF was 9.5%, diabetes 13%,
and pneumonia 0%.
Conclusion:
Approximately
$245,000 in readmission costs was saved,
outweighing the costs of staff providing
the service. The implication of this study
is that pharmacist-provided discharge
services significantly reduce readmissions, especially when medications are
provided at bedside and with successful
follow-up.
Q 146—ADVANCING THE ROLE OF
THE PHARMACY TECHNICIAN:
MEDICATION RECONCILIATION.
Rodriguez Esquire A, Turner P, Vera D,
Fort Belvoir Community Hospital, Email: antonio.h.rodriguezesquire.mil@
health.mil
this study is to determine whether a certified pharmacy technician (CPhT) can
perform admission medication reconciliation at a 90% accuracy rate compared
with a pharmacist.
Studies have demonstrated that
medication discrepancies on admission
and discharge pose an increased risk for
adverse drug events (ADE). If this task
can be delegated to a CPhT, pharmacists
can spend more time on the clinical aspects of their jobs.
Methods: A CPhT with at least 1 year
of experience in the pharmacy operation
was trained by a clinical pharmacist until
3 consecutive medication reconciliations
were performed without errors. CPhT reviewed outpatient and inpatient medical
records from 3 different databases. Medication history also was obtained by interviewing patients or their family member.
All discrepancies were documented in
the Medication Reconciliation Form.
Providers’ medication errors on inpatient medication orders were classified
j apha.org
as omissions, wrong medication, wrong
dose, and wrong frequency. The pharmacist independently performed medication reconciliation on each patient to
validate the CPhT’s data. All results were
tabulated in an Excel spreadsheet and all
data analysis was performed using SPSS.
Results: From May 1 to July 31, the
CPhT performed medication reconciliation on 64 (19%) of 336 patients admitted to family medicine. The patient ages
ranged from 18 to 97 years; approximately 52% were female. CPhT identified 17
patients with a total of 28 medication
discrepancies (19 omission, 3 wrong
medication, 2 wrong dose, 2 wrong frequency). CPhT completed medication
reconciliation incorrectly for 4 patients
(3 wrong medications, 1 wrong dose).
CPhT performed medication reconciliation at a 93.7% accuracy rate. Pharmacist’s time spent on medication reconciliation was reduced by 73%, allowing the
pharmacist to spend more time on direct
patient care.
Conclusion: Results of this study
demonstrated that a trained CPhT is as
effective as a registered pharmacist at
performing medication reconciliation
and identifying medication discrepancies
Original Citation: Rodriguez Esquire A, Phoung T, Vera D. Advancing
the Role of the Pharmacy Technician:
Medication Reconciliation. JAPhA 2013;
53:e151-170.
147—COORDINATION OF CARE
IN OUTPATIENT PRACTICE SETTINGS: PREVALENCE OF MEDICATION DISCREPANCIES AND DRUG
THERAPY PROBLEMS IDENTIFIED
BY A COMMUNITY PHARMACIST.
Smith M, University of North Carolina
at Chapel Hill Eshelman School of Pharmacy, Eker A, Kerr Drug, Marciniak M,
Ferreri S, University of North Carolina at
Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected]
Objective: Studies of medication
reconciliation are extensive within transitions of care between inpatient hospital
settings and outpatient clinics. However,
a gap in the literature exists in coordinating patient care among different outpatient settings. Medication reconciliation
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managed by community pharmacists
could meet this need and improve coordination of care. The objective of this
study is to determine prevalence of
medication discrepancies and drug therapy problems identified by a community
pharmacist utilizing patient medication
lists from all ambulatory care providers,
specialists, and pharmacies.
Methods: This cross-sectional descriptive study will be conducted within
1 store of a regional pharmacy chain. Patients taking ≥5 medications filled from
January 1 through October 1, 2013 and
who see ≥2 providers will be included
in the study. Patients <18 years of age or
patients with a “do not call” status will
be excluded. A community pharmacist
will request medication lists from each
provider of eligible patients and will
reconcile medications with pharmacy
dispensing records and patient-reported
medication lists. Patients will be contacted by phone to ensure all prescribers
and medications are included. Medication discrepancies and drug therapy
problems will be recorded using a standardized medication reconciliation form
developed by the investigators. Notifications of discrepancies found and recommendations to resolve drug therapy
problems will be faxed to all providers.
The number of medication discrepancies
and drug therapy problems will be analyzed using linear regression to control
for age, total number of providers, recent
hospitalization or emergency room visit,
and total number of medications.
Results: Research in progress. Institutional review board approval anticipated in October 2013. A total of 100
patient profiles will be reviewed. Data
analysis will occur from October 2013
through January 2014, with results available in March 2014.
148—AN EVALUATION OF A PHARMACIST’S IMPACT ON 30-DAY READMISSION RATES COMPARED
WITH THE CURRENT STANDARD
OF CARE. Tedesco G, McConaha J, Higginbotham S, Skomo M, Duquesne University, E-mail: [email protected]
Objective: This study seeks to evaluate the effect transition of care follow-up
and counseling performed by a phar-
e130 JAPhA | 5 4:2 | M AR/AP R 2014
macist, within a physician’s practice,
can have on 30-day hospital readmission among Medicare participants when
compared with the current standard of
care in a similar practice.
Methods: Patients aged ≥65 years,
with Medicare insurance, who were recently discharged from a local hospital
will be contacted by a pharmacist or student pharmacist via phone within 3 business days after discharge. It is estimated
that in a 24-week period, approximately
220 patients in the pharmacist intervention group and 220 patients in the standard of care group will be eligible for
the study (n = 440). During the call, the
pharmacist will perform a medication
reconciliation, review instructions given
at discharge, and schedule the patient for
a follow-up physician appointment in
conjunction with a face-to-face pharmacist-provided medication therapy management. A pharmacist also will review
the patient’s electronic medical record
and communicate recommendations to
the physician to address any gaps or issues identified. The current standard of
care, which does not involve a pharmacist, at a similar local physician practice
will be used as a comparative group. The
30-day readmission rates for both physician practices will be compared at the
conclusion of the study through the use
of chi-square test to determine statistical
significance.
149—HOSPITAL TO HOME: A COORDINATED EFFORT BETWEEN
A RURAL HOSPITAL AND COMMUNITY PHARMACY TO REDUCE
READMISSION RATES FOR HIGHRISK PATIENTS. Frye C, University of
School of Pharmacy, Huie C, Roark A,
Chapman A, Ferguson L, Brame Huie
Pharmacy, Marciniak M, Ferreri S, University of North Carolina at Chapel Hill
Eshelman School of Pharmacy, E-mail:
[email protected]
Objective: Patients with certain disease states are frequently readmitted to
the hospital. This undesirable outcome
increases health care costs. The Centers
for Medicare and Medicaid Services reduces reimbursement to hospitals with
ja p h a .org
high readmission rates. The purpose of
this study is to reduce 30-day and 90-day
hospital readmission rates for high-risk
patients. Secondary analyses will include
cost savings to the hospital.
Methods: This is a prospective cohort study. A community pharmacist
will be stationed in a local hospital for 3
hours each weekday to provide services
to patients with heart failure, myocardial infarction, pneumonia, or chronic
obstructive pulmonary disease. Patients
will be identified by case managers and
referred to the pharmacist. The pharmacist will have access to patients’ medical
records at the hospital and will be able
to communicate directly with hospitalists. Pharmacist-provided services
for participating patients will include
discharge medication reconciliation,
medication and disease state education,
delivery of a personal medication record, and discharge summaries sent to
the patient’s primary care provider and
community pharmacy. Pharmacists will
follow up with patients days 1, 7, 28, and
84 post-discharge. A helpline also will be
available to patients at any time. Readmissions within the 30-day and 90-day
period will be identified by the case managers. Statistical analysis to compare readmission rates for patients participating
in the program with nonparticipants will
be performed using 2 sample independent t tests. For a secondary outcome, the
hospital will provide estimated cost savings for patients who participate in the
program.
Results: Research in progress. Institutional review board approval is anticipated October 2013.
150—IDENTIFICATION OF MEDICATION DISCREPANCIES BY COMMUNITY PHARMACISTS DURING
A COMPREHENSIVE MEDICATION
REVIEW IN PATIENTS 1 WEEK
POST HOSPITALIZATION. Took R,
Balls Foods Stores, Liu Y, Kuehl P, University of Missouri–Kansas City, E-mail:
[email protected]
Objective: The study site is a selfinsured regional grocery store chain with
2,626 covered lives. The company provides many employee wellness services
including disease state management for
APhA2014 ABSTRACTS
diabetes, hypertension, and hyperlipidemia (6 to 8 pharmacist-led sessions per
year); smoking cessation classes; health
screenings; and immunizations. The
most recent service added is for pharmacists to provide a comprehensive
medication review (CMR) to employees
within 1 week of being discharged from
a hospital or intermediate level of care.
The purpose of this study is to determine
the number of medication discrepancies
and severity of drug-related problems
resolved when performing a CMR for
these employees.
Methods: Pharmacists began providing CMRs to discharged employees
in October 2013. This study is a retrospective review of the CMR records to assess
the data collected for employees seen
from October 1, 2013 to March 31, 2014.
Discrepancies will be identified among
employees’ medication regimens before admission, after discharge, and actual medications taking post discharge.
Medication-related problems will be
placed into the following categories: (1)
additional drug therapy; (2) unnecessary
drug therapy; (3) wrong drug; (4) dosage
too low; (5) dosage too high; (6) adverse
drug reaction/drug interaction; and (7)
adherence. Interventions will be categorized using the severity scale employed
by OutcomesMTM. This project will be
submitted to the University of Missouri–
Kansas City Adult Health institutional
review board as exempt research. Chisquare and Wilcoxon rank-sum tests will
be used to compare data.
Results: Research in progress. By assessing the types of discrepancies found
and assigning value to the severity of
medication-related problems resolved,
this project aims to determine whether
this service results in positive outcomes
for the company’s employees who are
hospitalized.
151— PH A R M AC IST-PROV I DED
MEDICATION RECONCILIATION
TO IDENTIFY MEDICATION-RELATED PROBLEMS IN A COMMUNITY SETTING. Jacquez M, Moorman
K, Owen D, McAdam-Marx C, Jennings
B, University of Utah, E-mail: macheala.
[email protected]
Objective: Performing medication
reconciliation is important in the care of
patients to reduce the risk of medicationrelated problems (MRPs) and is a national patient safety goal. With limited
health-system resources, it is important
to assess the impact of medication reconciliation and to target these services
to patients at greatest risk of MRPs. The
objectives of this study are to: (1) measure the quantity and type of MRPs encountered during pharmacist-performed
medication reconciliations in the community setting; and (2) identify patient
factors associated with the highest risk of
having MRPs.
Methods: This study is a descriptive cross-sectional analysis of a current
quality improvement program underway at a university health system. Investigators will collect information from
pharmacist-performed medication reconciliations in patients who are taking ≥7
medications, have ≥2 disease states, and
are currently receiving care at a university health center. Descriptive statistics
will be used to describe identified MRPs,
potential adverse events avoided, and
patient characteristics that are associated
with MRPs. Recommendations will be
made to providers to resolve the MRPs
identified. Provider response will be captured by whether or not they are fully accepted, partially accepted, or denied.
Mental Health
152—ASSESSING THE MECHANISM OF ACTION OF PHARMACEUTICALS FOR PSYCHIATRIC
AND NEUROLOGICAL DISORDERS APPROVED IN THE UNITED STATES, 1980–2012. Montagne
M, Araujo-Lama L, Kwon S, SeoaneVazquez E, Massachusetts College of
Pharmacy and Health Sciences University, E-mail: michael.montagne@mcphs.
edu
was to assess the mechanisms of action
(MOA) of pharmaceutical products approved for psychiatric and neurological
disorders from 1980 through 2012.
Methods: The MOA description in
the Clinical Pharmacology section of the
Food and Drug Administration (FDA)–
j apha.org
approved product label of new molecular entities from 1980 through 2012 was
collected from FDA and National Institutes of Health websites. Classifying the
status of a drug’s MOA was performed
by 3 researchers, based on exact wording, into the following 3 categories:
known, unknown, and hypothesized.
Based on the World Health Organization’ s Anatomical Therapeutic Chemical
(ATC) classification system, analysis was
at the level of the therapeutic-pharmacological group (ATC-3).
Results: Of a total 902 pharmaceutical products approved during this
time frame, 110 (12.2%) psychiatric and
neurological product MOAs were assessed. MOAs are known for 11.8% of
these products, unknown for 16.4%, and
hypothesized for 71.8%. Categories with
highest proportion of known MOAs
were parasympathomimetics (100%, n =
1) and drugs used in addictive disorders
(50%, n = 6). Categories with the lowest proportion of known MOAs were
general anesthetics (11%, n = 9), dopaminergic agents (10%, n = 10), and antipsychotics (9%, n = 11). In 7 of 16 categories, all products (n = 49) had no known
MOA. The proportion of products with
a known MOA has fluctuated over the
past 3 decades. Bivariate analysis did
not find a statistically significant difference in proportion of known MOAs for
orphan drug status and for market discontinuation. Results show lack of consistency in describing MOAs in product
labeling and limited compliance with
FDA guidelines.
Conclusion: Most nervous system
drugs did not have a confirmed MOA.
Policy recommendations for the FDA
include: develop a standardized template for the product label with regard to
MOA; require compliance with its guidelines and template; require clear hypothesis of MOA with supporting evidence
when definitive MOA is not known; and
encourage manufacturers to continue
post-marketing research to confirm hypothetical MOAs.
153—BUPROPION FOR THE TREATMENT OF ATTENTION-DEFICIT/
HYPERACTIVITY DISORDER IN
CHILDREN AND ADOLESCENTS.
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JAPhA e131
APhA2014 ABSTRACTS
Shah B, Penaloza J, Medina M, Palm
Beach Atlantic University, E-mail:
[email protected]
is to observe the effects of bupropion versus methylphenidate for the treatment of
attention-deficit/hyperactivity disorder
(ADHD) in adults and children.
Methods: Three randomized, double-blind, intent to treat, placebo and
non-placebo controlled trials were studied. First trial: Patients received bupropion XL 150 mg QAM for the first week,
bupropion XL 300 mg QAM for weeks
2–4 (if not indicated to increase dose
then stayed at 300 mg for the remaining 4
weeks), and bupropion 450 mg for weeks
5–8 (increased dose if: score >2 on the
Clinical Global Impressions (CGI) scale,
had an improvement in the ADHD Rating Scale (ADHD-RS) of <30%, or did
not experience any bothersome adverse
events). The primary outcome was the
percentage of subjects with at least a
30% reduction in the investigator-rated
ADHD-RS score from randomization to
week 8 or on premature discontinuation
from the study. Second trial: Bupropion
was started at 50 mg for patients <30 kg
and 75 mg for patients >30 kg and then
titrated up to 100–150 mg/day (100 mg/
day for <30 kg and 150 mg/day for >30
kg) or methylphenidate 20–30 mg/day
(20 mg/day for <30 kg and 30 mg/day
for >30 kg). The primary outcome was
the change in scores of the parent version
of ADHD-RS-IV from baseline to week
6 in each group. Third trial: There was a
7-day placebo lead-in. Patients were then
randomized into bupropion, methylphenidate, or placebo for the next 7 weeks.
Results: The results of the first trial
showed that bupropion significantly
showed a reduction in the ADHD-RS
score. The results of the second trial
showed that there was no significant difference in the change in parent ADHDRS-IV score between bupropion and
methylphenidate. The results of the third
trial showed that bupropion had a greater response on the CGI scale.
Conclusion: Bupropion can be considered as an alternative treatment for
ADHD based on clinical trials. It is an effective nonstimulant for patients unable
to tolerate stimulants such as methylphe-
e132 JAPhA | 5 4:2 | M AR/AP R 2014
nidate.
154—COMPARISON OF HEALTH
CARE UTILIZATION AND COSTS
ASSOCIATED WITH PATIENTS
WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER INITIATED ON DIFFERENT STIMULANTS. Desai P, Lawson K, The
University of Texas at Austin, E-mail:
[email protected]
study is to compare health care costs and
utilization in attention-deficit/hyperactivity disorder (ADHD) patients initiated on immediate- and extended-release
amphetamine and methylphenidate
using a propensity score (PS) matching
technique.
database analysis using Texas Medicaid
data. Patients initiated on immediaterelease amphetamine (IR-A), extended-release amphetamine (ER-A) and
immediate-release
methylphenidate
(IR-M) were matched to those initiated
on extended-release methylphenidate
(ER-M) (reference group) using a PS
caliper matching algorithm. Bivariate
analyses were conducted to compare
demographic and clinical characteristics
before and after matching. The primary
outcome measures were all-cause health
care resource utilization and costs and
ADHD-related drug and medical costs.
Logistic regressions, generalized linear
models regressions, and 2-part models
were used to compare health care utilization and costs post matching.
Results: Of the 15,055 patients included in the study, 64.7% were prescribed ER-M, 6.4% IR-M, 25.4% ER-A,
and 3.5% IR-A. Patients prescribed IR-M
had higher mean (95% confidence interval) ADHD-related drug costs compared with the ER-M group ($405 [$398,
$413] vs. $389 [$381, $396]), while those
in the ER-A group had higher ADHDrelated drug costs compared with the
ER-M group ($405 [$397, $413] vs. $381
[$381, $396]) but patients prescribed IRA had lower ADHD-related drug costs
($206 [$187, $226] vs. $388 [$366, $410])
compared with those prescribed ER-M.
ER-A initiators had significantly higher
emergency room (ER) costs compared
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with the ER-M group ($59 [$52, $66] vs.
$49 [$43, $55]) and were 1.14 times more
likely to have an ER visit (1.14 [1.01, 1.29],
P = 0.0330). Patients prescribed IR-A
had higher post-index office visit costs
($434 [$388, $480] vs. $362 [$325, $399])
compared with the ER-M group. None
of the other differences were statistically
significant.
might help guide decisions regarding
initial drug therapy for patients newly
diagnosed with ADHD and help Pharmacy and Therapeutics Committees in
making formulary decisions.
155—CORRELATION
AMONG
STROKE OCCURRENCE, DEMENTIA, AND ATYPICAL ANTIPSYCHOTIC. Chen K, LeBlanc B, Pansawira
C, University of California–San Francisco, E-mail: [email protected]
Objective: This study aims to find
the risk ratio between the occurrence of
stroke and the administration of atypical
antipsychotics in patients with dementia.
Methods: This retrospective cohort
study is awaiting final approval from a
Northern California HMO institutional
review board, after local facility approval had recently been granted. Electronic
medical records for 2,400 patients with
an International Classification of Diseases–9th revision code of dementia will be
reviewed to determine the rate of stroke
among patients who have used atypical
antipsychotic. This review will look at
prescription records from 1990 to 2013
for atypical antipsychotic prescription
fills as well as the diagnosis codes indicating stroke. All data were de-identified
and kept confidential during analysis.
Included patients are men and women
aged ≥50 years. This review also will examine comorbidities in the patient population (e.g., diabetes, hypertension, hyperlipidemia) for potential contributory
factors in stroke occurrence. Upon completion of the records review, analysis
will be completed to determine the rate
of stroke occurrence in dementia patients
who had received atypical antipsychotic
medication therapy, as well as the risk
ratio due to such therapy.
Results: Research in progress. Pre-
APhA2014 ABSTRACTS
liminary result conducted on 100 of 2,400
patients revealed no difference in stroke
occurrence between dementia patients
on atypical antipsychotics and those not
taking atypical antipsychotics.
156—CORRELATION
BETWEEN
MEDICATION REGIMEN COMPLEXITY AND REHOSPITALIZATION RATES IN SCHIZOPHRENIC
PATIENTS. Mathis S, University of Mississippi School of Pharmacy, Bell A, University of Mississippi Medical Center,
Objective: The purpose of this
study was to use the Medication Regimen Complexity Index (MRCI) to determine whether there is an association
between medication regimen complexity (MRC) and time to rehospitalization
in schizophrenic patients. Fifty percent
of schizophrenic patients are nonadherent to prescribed regimens, and this can
lead to increased rehospitalization rates.
Many studies have examined reasons for
poor adherence to medications in schizophrenic patients, but few studies have
measured MRC as a predictor of rehospitalization in this population. The MRCI
is a validated tool used to quantify MRC.
Methods: Patient charts were identified using International Classification of
Diseases–9th revision diagnosis codes
for schizophrenia. Charts were narrowed down to patients hospitalized for
psychiatric purposes. Inclusion criteria
were as follows: aged 18 to 65 years, hospitalized at least twice between January
1, 2008 and May 31, 2012, and having diagnosis codes of 295.XX (schizophrenic
disorders) on discharge. Patient charts
were excluded if no discharge medications were listed. Lengths of time between previous hospitalization and rehospitalization were measured in days
and compared with correlating MRCI
scores from discharge medication lists
using descriptive statistics and scatterplot analysis (coefficient of determination and P values).
Results: In this study, 209 charts
were reviewed; 96 were excluded and
113 were included. Median MRCI scores
were 11 for all discharge medications
and 7 for psychiatric medications only.
Median days to rehospitalization was
187. Results from analysis of scatterplots
were as follows: all discharge medications, R2 = 0.0047 (P = 0.384); psychiatric
medications only, R2 = 0.0085 (P = 0.244).
No significant correlation was shown
between MRCI scores for all discharge
medications or for psychiatric medications only and time to rehospitalization.
Conclusion: It cannot be concluded
that MRCI scores and time to reshospitalization for schizophrenic patients are
directly correlated. It is likely that a large
number of factors interplay to lead to
rehospitalization in this patient population.
157—HEALTH CARE PROFESSIONAL AND PATIENT KNOWLEDGE
OF PHARMACIST-ADMINISTERED
LONG-ACTING INJECTABLE ATYPICAL ANTIPSYCHOTICS IN INDEPENDENT PHARMACIES. Mercadel
C, Samford University/FMS Pharmacy,
Elmore L, Samford University, E-mail:
[email protected]
Objective: The purpose of this project is to assess health care professional
and patient knowledge of pharmacistadministered long-acting injectable
(LAI) atypical antipsychotics. The prescriber survey also aims to promote
collaboration between physicians and
pharmacists and to improve patient
care. This study has the potential to inform independent pharmacists, patients,
and health care professionals about best
practices of pharmacists who administer
LAI atypical antipsychotic medications.
It also may help improve collaboration
with physicians in the nearby geographic area.
Methods: Following institutional
review board approval, this qualitative
study will be completed in 2 parts. Part
1: Following informed consent, a survey
will be administered orally to health care
professionals and will assess knowledge
of pharmacist-administered LAI atypical
antipsychotic medications in an independent pharmacy. The survey consists
of multiple-choice questions and shortanswer questions. Health care professionals, including physicians, residents,
and/or nurse practitioners who currently prescribe any antipsychotic drug
(oral or LAI) will be identified utilizing
j apha.org
pharmacy dispensing software (McKesson Pharmacy Rx database). Fifteenminute appointments in medical offices
surrounding 3 independent pharmacies
will be set up for interviewing purposes.
Part 2: A paper survey will be administered to any patient at checkout from
the pharmacy to assess knowledge of
pharmacist-administered LAI atypical
antipsychotic medications in the independent pharmacy. Upon completion,
results will be dropped anonymously
into a manila envelope to protect patient
identities. This survey consists of several
multiple-choice questions. Qualitative
analysis will be used to evaluate both
sets of data to identify common themes
among prescribers and patients.
158—IDENTIFYING
PHARMACISTS’ PERCEPTION, KNOWLEDGE, AND PERCEIVED BARRIERS TOWARD PROVIDING CARE
TO PATIENTS TAKING ANTIPSYCHOTICS. Gangal N, Holiday-Goodman M, Vaidya V, Bechtol R, University of Toledo, E-mail: [email protected]
is to: (1) assess pharmacists’ attitudes,
subjective norms, self-efficacy, and intention toward providing additional care
to mental health patients; (2) determine
pharmacists’ knowledge of antipsychotics; (3) determine the best predictor of
intent for providing care considering
knowledge, attitude, self-efficacy, and
subjective norms; and (4) evaluate the
barriers in providing care to patients taking antipsychotics.
Methods: This was a prospective
study design using pharmacists working
in Ohio. Data were collected and analyzed using an online survey and SPSS,
respectively. Questions focused on following constructs of a modified Theory
of Planned Behavior: attitude, subjective
norm, knowledge, self-efficacy, and intention. Descriptive statistics and multiple regression were used.
Results: Nearly 10% of the pharmacists responded. Approximately 95% of
the respondents had positive attitudes
toward providing additional care to
mental health patients. Approximately
MA R /APR 2014 | 54:2 |
JAPhA e133
APhA2014 ABSTRACTS
89% had positive subjective norm. Pharmacists felt motivated to provide counseling depending on pharmacists’ desire
and patients’ needs. Almost 68% had
high perceived self-efficacy in providing
care to patients taking antipsychotics.
Approximately 90% of pharmacists intended to provide additional care to patients taking antipsychotics. Descriptive
statistics showed that only 20% of pharmacists had high scores on the knowledge section (40% or higher points).
Regression showed the factors that significantly predicted intention to counsel
were attitude (beta = 0.188; P<0.05) and
subjective norm (beta= 0.144; P<0.05).
Lack of time to individual attention and
lack of knowledge were the top 2 barriers
perceived by 90% and 80% of the pharmacists, respectively.
Conclusion: Overall, pharmacists
had a positive attitude and strong intention toward providing additional care
to mental health patients. A majority
of pharmacists surveyed showed limited knowledge on 7 questions related to
proper use of antipsychotics. Therefore,
it is important to raise knowledge among
pharmacists on antipsychotics. Continuing education programs could be helpful
to pharmacists in this process.
159—PERCEPTIONS OF THE USE
OF ALTERNATIVE THERAPIES
FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND THE
PHARMACIST’S ROLE IN THE INITIATION OF TREATMENT. Andanar
D, Gatewood S, Moczygemba L, Virginia
Commonwealth University, Carson R,
Martin’s Food Stores, Goode J, Virginia
Commonwealth University, E-mail: [email protected]
identify caregiver or patient perceptions
of the pharmacist’s role in the initiation
of treatment of attention-deficit/hyperactivity disorder (ADHD); and (2) identify perceptions of the use of alternative
therapies for the treatment of ADHD.
Methods: This is a cross-sectional
survey. The participants will be patients
>18 years of age and caregivers of children who have participated in a pharmacy-based ADHD service in the Richmond, Virginia, area. The ADHD service
e134 JAPhA | 5 4:2 | M AR/AP R 2014
is a pharmacist-physician collaboration
to determine the best initial treatment
option for a patient with ADHD. The
survey will assess patient or caregiver
perceptions of the pharmacist’s role in
this service, comfort with pharmacist’s
involvement in the service, and confidence in the pharmacist’s knowledge
about ADHD medications. The survey
also will assess patient and caregiver
perceptions on herbal and dietary supplements for the treatment of ADHD.
The survey will be pre-tested and revised based on feedback for content and
clarity. Descriptive statistics will be used
for data analysis in this study.
160—STIMULANT MEDICATION
UTILIZATION IN FOSTER AND
NON–FOSTER MEDICAID CHILDREN 3 YEARS OF AGE OR YOUNGER. Kim-Romo D, Rascati K, The University of Texas at Austin, E-mail: [email protected]
Objective: Current practice guidelines do not provide recommendations
for the evaluation of attention-deficit/
hyperactivity disorder in children before
the age of 4 years. While 1 study has evaluated the use of stimulants in children
aged 3 to 5.5 years, there is a dearth of
data evaluating the use of stimulants in
children aged 3 years and younger and
especially in children in foster care who
are at a higher risk for mental health disorders. The objective of this study was to
assess the use of stimulant medications
in foster care and non–foster care Medicaid patients aged 3 years or younger.
Methods: Texas Medicaid patient
and prescription claims data were analyzed for patients who were 0 to 3 years
of age at any time during the 2012 fiscal
year to determine stimulant medication
utilization and foster care status.
Results: A total of 1,130,260 patients
were 0 to 3 years of age, and 0.10% (n =
1,168) had at least 1 prescription claim for
a stimulant medication. Approximately
3.22% (51/1,585) of foster care children
were stimulant users compared with only 0.10% (1,117/1,128,675) of non–foster
care children. A logistic regression analysis adjusting for demographic variables
(sex and race/ethnicity) significantly
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showed that patients in the foster care
cohort were over 30 times more likely to
receive at least 1 prescription for a stimulant medication compared with patients
not in foster care (odds ratio [OR] = 30.93,
95% confidence interval [CI] 23.21–41.23,
P<.001). Of the other demographic variables, sex was the only significant predictor of stimulant medication usage, where
male patients were over 2 times more
likely to receive a stimulant medication
compared with female patients (OR =
2.69, 95% CI 2.36–3.07, P<0.001).
Conclusion: Overall, less than onetenth of 1% of Texas Medicaid patients
aged 3 years or younger utilized stimulants. Male patients and patients in the
foster care system had a significantly
higher likelihood of stimulant medication use compared with female patients
and non–foster care children, respectively.
Medication Therapy Management
161—ACHIEVING
DESIRED
HEALTH OUTCOMES IN THE REAL
WORLD THROUGH ASSESSING
AND INTERVENING TO IMPROVE
MEDICATION ADHERENCE: ADHERE. Bateman Jr. M, McConaha J,
Greco A, Duquesne University Mylan
School of Pharmacy, Lynch K, Pfizer Inc.,
study are to: (1) describe medicationtaking behaviors in patients seen in the
high-volume, grocery store chain pharmacy setting; and (2) identify barriers
that deter patients from adhering to their
medication regimens.
Methods: Medication nonadherence is a significant health care issue
among patients being treated for chronic
conditions, resulting in poorer medical
outcomes, higher hospitalization rates,
and increased health care costs. The goal
of this project is to collect information
about patients’ barriers to medication
adherence in addition to information
about patients’ sources and content of
medication knowledge. Results of this
study will better equip pharmacists for
the customization of patient counseling in the grocery store, community
APhA2014 ABSTRACTS
pharmacy setting. This project will use a
cross-sectional survey design to evaluate
patients’ medication-taking behaviors
and related parameters. Information
collected from the self-administered,
written survey will include patient demographics, chronic conditions for
which they are currently being treated,
and an assessment of medication adherence. This written survey also includes
questions from the Morisky scale with
additional questions to evaluate patients’ medication-taking behaviors and
related parameters. Technicians, student pharmacists, and pharmacists will
distribute and collect the surveys and
consent forms at the pharmacy counter.
The survey will be offered to patients of
the study pharmacy locations who are
>18 years of age and these patients may
decline taking the survey at any time.
Descriptive statistics will be reported for
each variable. Correlation analyses may
be conducted for the various clinical,
demographic, and patient perception
variables and the overall Morisky results. Each variable may be entered into
a regression model with the key outcome
variable being the Morisky score.
Results: Research in progress. Results may provide explanations for contributing factors leading to medication
nonadherence, allowing pharmacists to
offer more personalized patient counseling.
162—BRIDGING THE GAP BETWEEN CLINIC AND PHARMACY:
DEFINING THE ROLE OF THE COMMUNITY PHARMACIST IN TRANSITIONS OF CARE WITH HEART
FAILURE PATIENTS. Wingen H, University of Minnesota, Holtan H, Fischer
K, Hennepin County Medical Center,
Aytay M, Walgreens, E-mail: wing0125@
umn.edu
Objective: The objective of the study
is to evaluate the role of the transitional
care pharmacist in the care of patients
with congestive heart failure (CHF)
when given access to the patient’s electronic health record (EHR) in the community pharmacy setting. CHF is a leading cause for hospital readmission, with
50% of the 5.7 million American patients
living with CHF having a readmission
within the first 6 months following discharge. Admission related costs total
approximately $34.4 billion each year, a
significant amount. The emerging role of
a transitional care pharmacist attempts
to fill the gap in the continuum of care
that occurs between inpatient discharge
and the following readmission. Access
to the patient chart is key; without access
the community pharmacist is limited in
the involvement to help patients achieve
their health goals. Access to the patient
chart allows for the pharmacist to gain
insight into patients’ medical history, including the inpatient admissions related
to CHF, and the treatment plan.
Methods: This study will be submitted to the institutional review board for
approval. The large metropolitan healthsystem EHR will be used to identify recently discharged CHF patients with at
least 1 CHF-related hospital admission
and use specific Walgreens community
pharmacies near the health system clinic
to fill prescriptions. Approximately 5
Walgreens pharmacies will be utilized
for on-site in-person patient encounters and these encounters will occur at
baseline, which is within 2 weeks of discharge, 1 month post baseline encounter, and 3 months post baseline. Identified patients are given the choice to opt
in or out of the study. Patients will be
randomly selected from the same list of
identified potential participants to serve
as the control group. A protocol consisting of vitals, medication adherence
questions, and screens for worsening
CHF will be used to ensure consistency
of each patient-pharmacist encounter.
The pharmacist conducting the interventions will be a resident pharmacist with
access to ambulatory care pharmacists
for advising and will communicate with
the provider to initiate any interventions
involving medication changes. The pharmacist will primarily provide adherence
support, assistance in medication management, continued education related
to CHF with the ultimate goal to prevent
exacerbation that may lead to admission.
The data to be tracked is being determined.
163—CAN
COMPONENTS
OF
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MEDICATION THERAPY MANAGEMENT SERVICES BE INCORPORATED INTO ROUTINE PATIENT
COUNSELING?. Lester C, Chui M,
University of Wisconsin–Madison,
Helmke J, Kaefer T, Bremo Pharmacy,
Moczygemba L, Goode J, Virginia Commonwealth University, E-mail: calester@
wisc.edu
study is to develop and evaluate a process for integrating components of medication therapy management (MTM)
services into a community pharmacy
workflow.
Methods: This prospective, 3-month
observational study took place in an independent community pharmacy. The
intervention was a redesigned workflow
that included a seated private counseling area and focus on the pharmacist,
rather than the technician, being the
first contact when patients came into the
pharmacy. Process outcomes included
time spent with the patient; the number
of medication-related problems identified and recommendations made; and
disease education, immunizations, and
health monitoring tests provided. Satisfaction with the service was solicited via
a survey to patients and a focus group
with pharmacists.
Results: A total of 56 patients were
enrolled in the study resulting in 82 encounters. Forty medication-related problems, including experiencing adverse
drug event 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 8 immunizations were given. The revised workflow incorporating
components of MTM services into patient counseling was successful in that
39% of encounters were <2 minutes and
49% of encounters were 2 to 5 minutes in
length. Only 12% of encounters were >5
five minutes. Overall, patients were very
satisfied with the intervention. Pharmacists responded positively, but expressed
concern that the new workflow prevented them from overseeing technician
functions.
Conclusion: For pharmacists to proMA R /APR 2014 | 54:2 |
JAPhA e135
APhA2014 ABSTRACTS
vide MTM services, they need to be able
to incorporate it into their typical workflow. Unlike previous studies that have
required lengthy interaction, this study
may provide evidence that pharmacists
can expand their routine patient counseling to include components of MTM services in <5 minutes of direct interaction
with patients.
164—COLLABORATION TO IMPROVE OUTCOMES IN AN INTEGRATED MEDICARE MEDICATION THERAPY MANAGEMENT
PROGRAM. Jeong E, Kaiser Permanente Southern California, E-mail:
[email protected]
Objective: The purpose of this project is to describe outcomes achieved
from a Medicare medication therapy
management (MTM) model involving
ambulatory care pharmacists and support staff working under collaborative
practice agreements with physicians.
Methods: A large integrated health
care delivery system that provides medical services and prescription drugs to
both Medicare and non-Medicare members throughout the state of California
developed a Medicare MTM program
for eligible Medicare Part D patients.
The majority of the patient management was conducted over the phone and
consisted of medication reconciliation,
development of an action plan or recommendations, and generation of a current
medication list for the patient. The pharmacists worked collaboratively with the
physicians who allowed for initiation,
titration, and discontinuation of drug
therapy under pharmacist protocol to
improve various clinical and medication
safety outcomes.
Results: During the 2012 program
year, the program performed 30,772
comprehensive medication reviews
(CMRs) out of 40,233 patients who met
the program’s description. Clinical outcomes that were measured included
low-density lipoprotein (LDL) cholesterol control, A1C control, and medication adherence. The percent of Medicare
MTM patients achieving LDL <100 mg/
dL was 83% for patients with diabetes
and 82% for patients with coronary artery disease. Patients with diabetes with
e136 JAPhA | 5 4:2 | M AR/AP R 2014
A1C <9% was 89% and the adherence
rate (measured by proportion of days
covered) for biguanides, sulfonylureas,
and thiazolidinediones was 90%, 89%,
79%, respectively. Patients taking statins
had an adherence rate of 92%. The safety
outcome that was measured assessed
the percentage of patients that filled ≥1
prescriptions for a high-risk medication
(HRM). The percentage of Medicare
MTM patients who filled a HRM was 9%.
Patients who received a CMR were 23%
and 38% less likely to be hospitalized in
the 2010 and 2011 program years, respectively.
Conclusion: Collaboration with
physicians within a large integrated
health care system resulted in positive
outcomes that improved the quality of
care of Medicare MTM patients.
165—COMPARING
THE
COMPLEXITY OF PATIENTS SEEN FOR
MEDICATION THERAPY MANAGEMENT IN VARIOUS PRACTICE
SETTINGS. Smith K, University of Minnesota College of Pharmacy, Karg R, Supervalu Inc., Knutson A, Park Nicollet,
Riss J, Brands M, Supervalu Inc., E-mail:
[email protected]
study is to compare the complexity of
the patients seen for medication therapy
management (MTM) services in a community pharmacy setting with the complexity of the patients seen for MTM services in a clinic setting.
Methods: Records of patients seen
for MTM over a 6-month period at a
group of grocery store–based community pharmacies will be reviewed for the
age of the patient, the number of medications, number of medical conditions,
and number of drug therapy problems
identified during the visit. The data will
be compiled and averages calculated.
The same data will be complied from
data collected via a “smart form” in the
electronic medical record of a large clinic
group in the same geographic area for
the same time period for patients who
had been seen by a pharmacist for MTM
in the clinic setting. Results will be compared and statistical significance will be
determined using a t test.
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implications for practice are that by understanding the complexity of the patients seen by pharmacists in various
settings, pharmacists can ensure their
MTM services are meeting the needs of
the patients they serve and that the services they offer are meeting the highest
standards of patient care. This research
will be used to prove the value of clinical services offered in the community
pharmacy setting and to advocate for
easier access to patient medical records
for pharmacists offering these services.
166—COMPARISON OF THE NUMBER OF PATIENTS WITH MEDICATION CHANGES FOLLOWING
COMPREHENSIVE VERSUS TARGETED MEDICATION REVIEWS IN
A MEDICATION THERAPY MANAGEMENT PROGRAM. Buhl A, Augustine J, Chinthammit C, Boesen K,
University of Arizona, E-mail: kboesen@
pharmacy.arizona.edu
Objective: The objective of this project is to determine whether targeted
medication reviews (TMRs) or comprehensive medication reviews (CMRs) resulted in more medication changes in the
interest of improving patient outcomes.
Methods: This cross-sectional quality improvement (QI) project compared
the number of patients with positive
medication changes in CMR and TMRonly patients who qualified for the Medication Management Center’s pharmacist-driven medication therapy management (MTM) program in 2012. The addition of an appropriate medication or the
removal of an inappropriate medication
was considered a positive medication
change. Changes were verified by prescription claims 120 days post-intervention. Odds ratios (OR) were calculated
using Wilcoxon rank-sum. This was a
QI project, therefore it did not meet the
federal definition of research and institutional review board approval was not
required.
Results: A total of 418,649 qualified
patients were included in this project.
The CMR group consisted of 43,490 patients (10%) and the TMR-only group
consisted of 375,159 patients (90%) who
did not receive a CMR. Fifty-six percent
(n = 24,231) of CMR recipients and 47%
APhA2014 ABSTRACTS
of TMR-only recipients (n = 176,016) had
a pharmacist-initiated recommendation
sent to their prescriber (P<0.001). Thirty
percent (n = 7,369) of CMR recipients and
35% (n = 61,969) of TMR-only recipients
had a medication change following a
prescriber intervention (P<0.001). CMR
recipients were more likely to receive a
recommendation (OR 0.70, 95% confidence interval [CI] 0.69–0.72). TMR-only
recipients were more likely to have a
recommendation result in a medication
change (OR 1.24, 95% CI 1.21–1.28).
Conclusion: The TMR-only group
represented the majority of patients in
this project. While the percentage of
patients who received a recommendation in the TMR-only group was lower,
a greater percentage of these patients
received a medication change. This indicates that TMRs may be more effective in
producing a positive medication change
compared with CMRs.
167—COMPARISON OF THE PHARMACOKINETICS OF USL255, AN EXTENDED-RELEASE TOPIRAMATE,
WHEN SPRINKLED ONTO SOFT
FOOD OR SWALLOWED INTACT.
Clark A, Anders B, Upsher-Smith Laboratories Inc., E-mail: [email protected]
study is to evaluate bioequivalence between USL255 beads sprinkled onto soft
food compared with the intact USL255
capsule. USL255 is a once-daily extended-release formulation of topiramate
developed for the treatment of epilepsy.
Because some patients with epilepsy
may have difficulty swallowing tablets
or capsules, USL255 was formulated to
allow the capsule to be opened and the
beads sprinkled onto soft foods.
Methods: This was a phase 1, randomized, open-label, single-dose, crossover study of 36 healthy adult volunteers
who received 200 mg USL255 administered as an intact capsule or sprinkled
onto 1 tablespoonful of applesauce.
Blood samples were collected for 14 days
post-dose and pharmacokinetic parameters were calculated, including area under the plasma concentration–time curve
(AUC0–∞, AUC0–t), maximum concentration (Cmax), time to Cmax (Tmax), and termi-
nal elimination half-life (t1/2). AUC and
Cmax were considered bioequivalent if
the 90% confidence intervals (CI) for the
ratio of geometric least-squares means
(GLSM) were contained between 0.80–
1.25. Tolerability was evaluated through
adverse event (AE) monitoring, vital sign
measurements, and clinical laboratory
evaluations.
Results: AUC and Cmax were bioequivalent between USL255 200 mg
administered as an intact capsule and
sprinkled onto soft food (GLSM [90%
CI]: AUC0–t 1.01 [0.97–1.04]; AUC0–∞ 1.02
[0.98–1.05]; Cmax1.09 [1.03–1.14]). Median
Tmax was 10 to 14 hours and t1/2 was similar for both administration methods (81.5
hour intact; 83.6 hour sprinkled). USL255
was generally well tolerated, with similar types and numbers of AEs reported in
both groups.
Conclusion: USL255 beads sprinkled
onto soft food demonstrated bioequivalence for AUC and Cmax compared with
the intact capsule. Therefore, USL255 can
be a useful treatment option for individuals with difficulty swallowing.
168—COST OF INTERMITTENT
PARTICIPATION IN MEDICATION
THERAPY MANAGEMENT. Pinto S,
Bechtol R, Conner T, The University of
Toledo, E-mail: tessa.conner@rockets.
utoledo.edu
is to examine the cost spending associated with intermittent participation in an
employer-sponsored medication therapy management (MTM) program.
Methods: This is a prospective, longitudinal, multi-site study conducted at
7 community pharmacies across Northwest Ohio beginning in 2005. Pharmacists counseled patients at 3-month
intervals. Eligible patients had to have
primary medical insurance and prescription coverage through the employer and
a primary diagnosis for diabetes with
or without other comorbid conditions.
Of the 650 participants enrolled in the
study, 310 were identified as intermittent
participants. For this study, intermittent
participants were defined as those patients who enrolled in the program for
2 years, dropped out for a 2-year period,
and then returned. Retrospective data for
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2 years prior to entering the program was
obtained and participants were tracked
for a total of 5 years following enrollment. Costs for physician office visits,
emergency department visits, hospitalization, and total health care costs were
examined.
Results: Cost spending for the time
period participants received MTM was
observed to be less than pre-intervention. After 2 years in the program, participants who dropped out saw an increase
in cost spending comparable to the preintervention period. Upon returning to
the program, a decrease in cost spending
was observed. For example, the average
cost to the employer per patient per year
(PPPY) was approximately $390 prior to
enrollment. After 2 years in the program,
the cost PPPY was observed to decrease
to $175. Following a 2-year drop out, cost
increased to $350 PPPY. Costs decreased
to $200 during the rejoined year. This
trend was observed for all 4 variables included in this study.
Conclusion: This study attempted
to capture cost spending when patients
drop out of the MTM program. Results
indicate a rise in spending during the
post-participation dropout period. Employers and payers should encourage
participants to continually stay enrolled
in MTM programs to realize sustained
cost savings.
169—DEVELOPING AND IMPLEMENTING AN INTERDISCIPLINARY TRANSITION OF CARE PROGRAM UTILIZING MEDICATION
THERAPY MANAGEMENT AND
THE PATIENT-CENTERED MEDICAL HOME MODEL ALONG THE
U.S.–MEXICO BORDER. Gomez J,
University of Texas El Paso/UT Austin
and Centro San Vicente, Padilla M, University of Texas El Paso/UT Austin, Email: [email protected]
Objective: The objectives of this innovative practice are to: (1) develop and
establish an interdisciplinary transition of care (ITC) program; (2) integrate
ITC into medication therapy management (MTM): (3) create a therapeutic
interchange program (TIP) protocol and
implement it with ITC; (4) categorize the
adverse events (AEs) avoided; and (5)
MA R /APR 2014 | 54:2 |
JAPhA e137
APhA2014 ABSTRACTS
measure patient satisfaction.
Methods: This is a descriptive, prospective study that will occur from July
2013 through 2014. A pilot group (5–10
patients) will be used to test the transition of care program from a hospital to
a federally qualified community health
center. The target population will include patients without insurance who
are frequent users of the emergency department and high-risk patients with
Medicare who have had a hospitalization within 12 months of the study. The
program will use pharmacists to conduct
MTM prior to the first provider visit.
This service may occur at the hospital
upon discharge, as a home visit, or at
the clinic. During the MTM visit, pharmacists will complete a comprehensive
medication review, medication reconciliation, provide a medication action plan
and personal medication list, and utilize
the TIP protocol to substitute medications given at discharge to clinic formulary agents. Pharmacists will track the
AEs avoided at each visit. In addition,
pharmacists will empower patients to
be active participants in their health care
through promotion of healthy behaviors
and preventative care. At the first provider visit, the electronic medical record
will reflect active regimens, which will
allow the provider to address more acute
concerns. A validated patient satisfaction survey (in English or Spanish) will
be given after the MTM visit to assess the
patient experience for quality improvement. This project serves as an example
of how pharmacists can contribute to the
patient-centered medical home model
and help alleviate access barriers in underserved populations.
170—EVALUATING THE IMPLEMENTATION OF A PHARMACISTLED TRANSITION OF CARE MEDICATION THERAPY MANAGEMENT
SERVICE IN AN UNDERSERVED
POPULATION. Stone N, Ulbrich T,
Awad M, Northeast Ohio Medical University, Kelling S, University of Michigan, E-mail: [email protected]
Objective: Medication therapy
management (MTM) can decrease
medication discrepancies after hospital
e138 JAPhA | 5 4:2 | M AR/AP R 2014
discharge and is a tool used to improve
patient outcomes. The primary objective
of this study is to measure the impact of
a transition of care MTM service between
local area hospitals and a federally qualified health center (FQHC). Measures of
service impact will include 30-day hospital readmission rates and number of
drug therapy problems identified and
resolved. The secondary objective is to
evaluate the service process measures including patient participation rates, usual
time to conduct the visit, and average
number of disease states and medications per patient.
Methods: All current adult patients
of the FQHC discharged from local area
hospitals from January 1, 2014 through
March 1, 2014 will be eligible for participation. The FQHC will use discharge
summaries received from local area
hospitals to identify qualifying patients.
Based on a standing order at the FQHC,
the patient will be contacted to schedule
a face-to-face pharmacy visit within 14
days of hospital discharge. Patient participation will be measured by the number of appointments scheduled, no-show
rates, and percent who decline the service. Potential and actual drug therapy
problems will be documented and forwarded to the patient’s provider via the
electronic medical record at the FQHC.
Directly following the encounter, time
to conduct the visit, number of disease
states, and number of medications will
be recorded. The medical record will be
reviewed 14 days after the encounter to
determine the number of recommendations accepted. Readmission within 30
days of hospital discharge will be determined if the FQHC receives 2 separate
discharge summaries within a 30-day
period. Descriptive statistics will be used
to report the data.
171—EVALUATION OF ECONOMIC
OUTCOMES FROM A PHARMACIST-PROVIDED
MEDICATION
THERAPY MANAGEMENT CLINIC
OVER 4 YEARS. Groves C, University of Maryland–Baltimore, Truong H,
University of Maryland–Eastern Shore,
Congdon H, University of Maryland,
Botchway R, Dang T, Primary Care Coja p h a .org
alition of Montgomery County, E-mail:
[email protected]
study is to evaluate economic outcomes
of medication therapy management
(MTM) services delivered in safety-net
clinics over a 4-year period.
Methods: High-risk patients with
multiple medications and chronic conditions were referred to an MTM clinic in a
Health Resources and Services Administration (HRSA) Patient Safety and Clinical Pharmacy Services Collaborative
(PSPC) for comprehensive medication
therapy review. Pharmacists identified,
prevented, and resolved medicationrelated problems (MRPs) including actual or potential adverse drug events
as a focus of the HRSA PSPC initiative.
Pharmacists’ recommendations were
reviewed and adopted by the collaborating physicians. The time spent during
face-to-face encounters with patients
was tracked utilizing the 3 MTM billing
codes: 99605 for the first 15 minutes of the
initial visit; 99606 for the first 15 minutes
for a follow-up visit; and 99607 for additional 15-minute increments of initial or
follow-up visits. A literature review was
conducted to extrapolate and quantify
the MRPs. Expense of MTM services, primarily pharmacists’ salary over 4 years,
also was calculated. All MRPs and pharmacists’ expenditure were determined
and used to evaluate the estimated cost
savings and return on investment (ROI)
to assess the potential economic outcomes for the health care system over a
4-year period.
Over a 4-year period, 246 patients were
provided MTM services yielding 566
30-minute encounters, which occurred
once weekly. Among those encounters,
billing code 99605 was utilized 245 times,
99606 was utilized 302 times, and 99607
was utilized 585 times. The amount of
pharmacists’ expense for all encounters
were calculated based on $2.70 per minute with 25% fringe benefits, providing a
total expenditure of $57,307.50 for 16,980
minutes. The estimated ROI is being determined pending data analysis of the
identified MRPs.
172—FALL RISK POTENTIAL AND
APhA2014 ABSTRACTS
THE BEERS CRITERIA ADDRESSED
BY
FOURTH-YEAR
STUDENT
PHARMACISTS
COMPLETING
MEDICATION THERAPY MANAGEMENT ACTIVITIES DURING
REQUIRED COMMUNITY ADVANCED PHARMACY PRACTICE
EXPERIENCES. Hale K, Brown S,
University of Montana Skaggs School
of Pharmacy, E-mail: katherine.hale@
umontana.edu
is to determine whether fourth-year student pharmacists address potential fall
risk and use of medications meeting the
Beers criteria when completing medication therapy management (MTM) activities during required community advanced pharmacy practice experiences
(APPEs).
Methods: Students completing required community APPEs at the University of Montana Skaggs School of
Pharmacy must complete a minimum of
1 MTM case during the 4-week rotation.
Care plans were included for analysis if
they were submitted during academic
year 2012–13 and involved patients who
were ≥65 years of age. Each care plan was
evaluated to determine if the student
addressed fall risk and the use of medications included in the 2012 American
Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use
in Older Adults. Patient demographics
including age, sex, and number and type
of medications meeting the Beers criteria
were gathered.
Results: Eighty care plans were submitted, and 33 met criteria for inclusion
in this review. Of the 33 patients, 18 were
female (55%) and 15 were male (45%).
The average patient was 75 years of age,
had 8 chronic disease states, and took
11 prescription medications and 4 overthe-counter medications. Four (12%)
students addressed potential fall risk,
and 2 (6%) students addressed the Beers
criteria in the assessment/plan. Ten patients did not take any medications meeting the Beers criteria, while the remaining 23 took an average of 2 (range 1–4).
Aspirin use, sliding-scale insulin, benzodiazepine and non-benzodiazepine
hypnotics, alpha-1 blockers, and tricyclic
antidepressants were the most common
medications meeting Beers criteria used
by the 23 patients.
Conclusion: In patient care plans by
fourth-year student pharmacists, potential fall risk and potentially inappropriate medication use in the elderly is rarely
addressed. This illustrates the need to
educate students on the importance of
assessing and managing issues specific
to geriatric patients.
173—FINAL RESULTS OF STUDENT
SELF-ASSESSMENT OF MEDICATION THERAPY MANAGEMENT
ACTIVITIES IN REQUIRED COMMUNITY ADVANCED PHARMACY
PRACTICE EXPERIENCES. Hale K,
Brown S, University of Montana Skaggs
School of Pharmacy, E-mail: katherine.
[email protected]
is to evaluate the change in student
knowledge, skills, and ability to identify,
assess, and resolve drug-related problems in medication therapy management
(MTM) encounters during a required
community advanced pharmacy practice experience (APPE).
Methods: Student pharmacists participating in required community APPEs must perform the core elements of
an MTM encounter with a minimum of
1 patient. A survey administered at the
end of the 4-week APPE evaluated student self-assessment of pre- and postAPPE knowledge, skills, and ability to
perform an MTM encounter based on 13
defined competencies. The survey also
collected information on student MTM
encounters, such as number and type of
encounters as well as time spent on each
encounter. Surveys were administered
over a 2-year period from May 2010
through May 2012.
Results: Over 2 years, 229 MTM encounters were completed by 95 student
pharmacists. Most students (43%) spent
5 to 8 hours on a single encounter. The
activity was rated as effective to very
effective by 94% of students. Self-assessment scores improved significantly from
baseline for all items (P<0.05), with the
highest change in communication with
primary care providers. Students rating
their ability as medium-high to high increased by 62% following the completion
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of the community APPE.
Conclusion: Implementation of
MTM activities in a required community
APPE significantly increased student
pharmacists’ knowledge, skills, and ability to perform an MTM encounter.
174—IDENTIFICATION AND RESOLUTION OF DRUG THERAPY PROBLEMS BY COMMUNITY PHARMACISTS THROUGH TELEPHONE
FOLLOW-UP AFTER CARE TRANSITIONS. Cross C, Patel D, New Albertsons Inc., Winkler S, Midwestern University Chicago College of Pharmacy,
Wagner M, New Albertsons Inc., E-mail:
[email protected]
is to describe the drug therapy problems
identified and resolved by community
pharmacists at 3 to 5 days and at 30 days
post-hospital discharge.
Methods: This is a single-center, prospective, descriptive study. Eligible subjects will be identified upon the presentation of a written or computer-generated
prescription on a hospital-affiliated
prescription blank to the community
pharmacy. Subjects will be included if
they meet 1 of the following criteria: discharged from hospital stay of ≥1 night,
discharged from a visit to the emergency department, or discharged from
a hospital-based outpatient procedure.
A pharmacist will call study subjects at 3
to 5 days post-discharge and at 30 days
post-discharge. During each phone call,
the pharmacist will assess for drug therapy problems and resolve them by means
of education and/or follow-up with the
primary care physician. All drug therapy
problems identified will be categorized
and documented according to a modified
classification system outlined by Cipolle
et al. Descriptive statistics will be used to
report the drug therapy problems identified and resolved by pharmacists at each
intervention. An algorithm also will be
applied to compiled drug therapy problems to determine cost savings associated with pharmacist interventions.
Results: Research in progress. Reimbursement provisions put forth in the
Affordable Care Act and current trends
of high hospital readmission rates have
made care transition interventions viMA R /APR 2014 | 54:2 |
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APhA2014 ABSTRACTS
tal to the sustainability of hospitals and
improvement of patient outcomes. It is
anticipated that this research will demonstrate the significant role community
pharmacists play in optimizing care
transitions through necessary drug therapy interventions.
175—THE IMPACT OF COMPREHENSIVE MEDICATION REVIEWS
PERFORMED BY COMMUNITY
PHARMACISTS IN COLLABORATION WITH EMERGENCY MEDICINE PHARMACISTS POST EMERGENCY DEPARTMENT OBSERVATION UNIT DISCHARGE: A TRANSITION OF CARE PILOT STUDY.
Long B, The Ohio State University, Kuhn
C, The Kroger Co., McAuley J, Shirk M,
Wehr A, Bennett M, The Ohio State University, E-mail: [email protected]
study is to identify the impact of comprehensive medication reviews (CMR)
performed by community pharmacists
in collaboration with emergency medicine (EM) pharmacists for patients discharged from an emergency department
(ED) observation unit (OU). Objectives
of the study are to: (1) compare the modified Care Transition Measure (CTM-15)
Medication Section results after OU discharge to after community pharmacistperformed CMR; and (2) identify and
quantify drug-related problems (DRP)
from the CMR.
Methods: The pilot study will occur
with patients discharged from an academic medical center ED OU, who participate in a CMR at a grocery store chain
community pharmacy. Patients will
be admitted to the OU per established
protocol. Eligible patients include those
>18 years of age with a specific Ohio
Managed Medicaid insurance plan and
diagnoses of cardiovascular disease (hypertension and congestive heart failure),
diabetes, and/or respiratory disease
(asthma and chronic obstructive pulmonary disorder). EM pharmacists will
enroll the patients, create a discharge
summary, and fax the summary to the
community pharmacist. The community
pharmacist will schedule and conduct a
CMR in accordance with the Medication
Therapy Management Core Elements
e140 JAPhA | 5 4:2 | M AR/AP R 2014
within 14 days of OU discharge. After
the CMR, the patient will be asked to
complete the survey instrument. A retrospective post-then-pre survey methodology will be used to identify the impact of
a CMR delivered by a community pharmacist after a patient experiences this
transition of care. This methodology will
be utilized to decrease response shift bias, which can be an issue when assessing
self-reported change. Additionally, the
community pharmacist will collect data
to quantify and describe DRP from the
CMR. Descriptive statistics will be used
to characterize the pilot study’s data.
176—THE IMPACT OF COORDINATION OF CARE IN COMMUNITY
PHARMACIST–DELIVERED MEDICATION
THERAPY
MANAGEMENT. Kleyman S, Snyder M, Purdue
[email protected]
Objective: This study aims to determine whether pharmacists identify more
health-related problems during medication therapy management (MTM) when
they engage in care coordination, defined as having access to health records
from a patient’s prescriber, in comparison with not having access. This study
also seeks to describe parts of the health
record used by pharmacists to identify
health-related problems and explore
whether care coordination during MTM
prevents hospital or emergency department utilization at 90 days post MTM.
Methods: After institutional review
board approval, community pharmacies
that deliver MTM without care coordination will be randomized to deliver either
usual MTM care or MTM with care coordination. A target of 150 patients eligible
for MTM through their Medicare Part D
plan will be enrolled. Pharmacists in the
care coordination arm will attain and review a target of the previous 6 months of
the patient’s health records. Pharmacists
in both arms will contact the patient 90
days post MTM and inquire on hospital
or emergency department utilization
and will record: patient demographics,
number and types of health problems
discovered, which parts of the patient’s
health records were used to discover
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health problems, and rates of hospitalization or emergency department utilization. Data will be analyzed using parametric and nonparametric statistics, as
appropriate.
Results: Research in progress. This
study will determine whether pharmacists who engage in care coordination
during MTM delivery discover more
health-related problems and, subsequently, whether their patients utilize
emergency departments and hospitals
less often.
177—IMPACT OF DELAYED-DOSE
ADMINISTRATION OF USL255,
AN EXTENDED-RELEASE TOPIRAMATE FORMULATION. Anders B,
Clark A, Upsher-Smith Laboratories Inc.,
study is to gain an understanding of
pharmacokinetic effects associated with
delayed administration of USL255.
USL255, a once-daily, extended-release
formulation of topiramate, was developed for the treatment of epilepsy. While
once-daily formulations may improve
patient compliance, delayed dosing may
cause steady-state plasma concentrations to decrease below minimum therapeutic concentrations.
Methods: Nonparametric superpositioning was used to simulate steadystate pharmacokinetic profiles from
single-dose USL255 200 mg data. A 14day dose administration (200 mg/day)
to achieve steady-state conditions was
simulated (full compliance), followed by
a 6-, 12-, 18-, and 24-hour (double dose)
simulated delay in dosing, with oncedaily dosing resuming after the late dose.
Mean-predicted topiramate concentrations were calculated for each delayeddose scenario and compared with full
compliance. Simulated minimum (Cmin)
and maximum concentrations (Cmax)
were evaluated for 96 hours following
the late dose.
Results: Mean predicted plasma
concentrations prior to the next scheduled dose decreased incrementally as the
time delay increased. However, within
24 hours after late-dose administration
(followed by compliant dosing), topiramate concentrations for all delayed-dose
APhA2014 ABSTRACTS
scenarios were similar by visual comparison to simulated full-compliance
concentrations. Concentrations were
generally highest 2 days after a USL255
dose was administered 6, 12, 18, or 24
hours late; mean Cmax values were 2.09%,
4.25%, 6.79%, and 11.85% higher than
steady-state concentrations, and corresponding Cmin values increased by 2.55%,
5.12%, 7.67%, and 10.23%. Three days
after delayed-dose administration, Cmax
and Cmin values were 1.14–7.03% and
1.33–5.31% higher, respectively, compared with compliant dosing.
Conclusion: After a USL255 dose
was administered up to 24 hours late,
simulated topiramate concentrations
returned to near steady state within
one 24-hour interval. These data demonstrate dosing USL255, up to 18 hours
after a missed dose (i.e., 6 hours before
the next scheduled dose), minimizes the
time that topiramate concentrations may
be below minimum therapeutic concentrations without significant risk of increased (>10%) Cmax.
178—IMPACT OF AN INPATIENT
MEDICATION THERAPY MANAGEMENT REFERRAL PROGRAM
IN AN INTEGRATED CARE DELIVERY SYSTEM. Born M, Carlson M, Ferkul K, Fairview Health Services, E-mail:
[email protected]
study are to: (1) evaluate a tool used to
identify patients to be referred for medication therapy management (MTM)
services; and (2) compare the number of
MTM referrals pre- and post-implementation.
Methods: Much attention has been
given to the use of MTM services in the
care transition period after a patient
discharges from the hospital. Presently,
health-system infrastructure precludes
referring every patient to an MTM provider, so a focus on how to refer and
which patients to refer to MTM providers is important. In this health system,
approximately 10% of hospital discharges could feasibly be seen by current MTM
pharmacy staff. This study is an evaluation of an electronic best practice alert
(BPA,) which was developed with pharmacist input as part of a system-wide
care coordination team. The purpose of
the tool is to identify patients in an academic medical center who may benefit
most from an MTM visit (i.e., high-risk
patients). The study will be approved
the University of Minnesota institutional
review board. During a 4-week trial period, the tool will be evaluated for its efficacy in identifying high-risk patients.
Manual review of patient charts will be
performed to ensure the tool is working
properly. The total number of BPAs will
be recorded and evaluated as percentage of all hospital discharges. During the
study period, a hospital pharmacist will
use the BPA to identify and refer patients
for an outpatient pharmacist-provided
MTM visit. The hospital pharmacist also
will visit the patient while admitted to
encourage follow-up with the MTM
visit. The BPA tool will retrospectively
be applied to patients from a similar time
frame 1 year previous to be used as a control. Descriptive statistics will be used to
evaluate the pre- and post-implementation data.
179—IMPACT OF A NATIONWIDE
MEDICATION THERAPY MANAGEMENT PROGRAM ON DRUGRELATED PROBLEMS AT THE MEDICATION MANAGEMENT CENTER
IN 2012. Tse B, Augustine J, University
of Arizona College of Pharmacy, Boesen
K, University of Arizona, E-mail: kevin.
[email protected]
Objective: The objective of this project is to compare provider acceptance
rates of medication therapy management (MTM) interventions initiated
by an MTM center for potential drugrelated problems in 2012. Interventions
included cost savings to patients, adherence to clinical guidelines, medication
adherence, and safety initiatives.
Methods: This retrospective crosssectional project measured the provider
acceptance rates of MTM interventions
for Medicare Part D beneficiaries. Intervention count and acceptance rates
were analyzed from the center’s MTM
software and database that utilizes prescription claims analysis post-intervention to determine intervention success.
A chi-square test was used to assess the
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statistical significance between the interventions. An alpha level of 0.5 was
determined a priori. This was a quality
improvement project, and institutional
review board approved this project as
exempt status.
Results: Thirty-five percent of
recommendations
were
accepted
(159,795/455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%),
adherence (12%), and guidelines (8%).
The acceptance rates for the 4 intervention types were statistically different
from each other (P<0.0001). Within each
intervention type, the most frequently
accepted interventions were: removal
of medications from the Beers criteria
(8% of safety-related changes); changes
from a brand name, non-oral medication
such as eye drops and nasal sprays, to
a generic within the same class (15% of
cost saving–related changes); improved
adherence to hypertension and diabetic
medications (29% of adherence-related
changes); and adding an antihypertensive agent to diabetic patients (62% of
clinical guideline–related changes).
Conclusion: Safety initiatives had
the highest acceptance percentage of all
4 intervention types. Approving more
safety interventions with medication use
may reduce the risk of morbidity and
mortality. Pharmacists providing MTM
services may want to increase focus on
drug safety as providers are accepting
more safety interventions. More research
is needed to determine why providers
approve the other recommendations at
lower rates.
180—IMPACT OF USING A PHARMACY RESIDENT TO TRAIN COMMUNITY PHARMACISTS ON A
WEB-BASED PROGRAM TO PROVIDE MEDICATION THERAPY
MANAGEMENT SERVICES. Kang S,
Schnucks Specialty Pharmacy, E-mail:
[email protected]
is to determine the effectiveness of using
a postgraduate year 1 (PGY1) community pharmacy resident in training pharmacy managers and staff pharmacists of
a retail pharmacy on using a web-based
program to provide medication therapy
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APhA2014 ABSTRACTS
management (MTM) services to eligible
patients.
Methods: The PGY1 pharmacy resident had introduced OutcomesMTM, a
web-based MTM program to 100 pharmacy managers of a privately owned
chain pharmacy in a short presentation
during the annual pharmacy managers’
meeting. Pharmacy managers were given time to register to set up an account,
complete the online training, and start
making MTM claims through the webbased program. All pharmacists were
encouraged to ask questions regarding
making claims to the pharmacy resident
via e-mail or phone. After at least 1 pharmacist at each store pharmacy had been
registered and approved to make MTM
claims by OutcomesMTM, the resident
traveled to each store pharmacy for a
15-minute live training session to reinforce the process of using the program.
Overall effectiveness will be determined
by comparing the total number of MTM
service claims made through the webbased program prior to the training
session and at 30 days and 60 days posttraining.
Results: Research in progress. Registration of all pharmacists has not yet
been completed.
181—IMPLEMENTATION
AND
EVALUATION OF SPECIALIZED
WORKFLOW FOR TARGETED INTERVENTIONS IN A GROCERY
STORE CHAIN PHARMACY. Yacko
C, Andring T, McGivney M, University
of Pittsburgh, E-mail: [email protected]
project is to implement and evaluate
the effect of a specified workflow on
completion rate and financial metrics of
OutcomesMTM Target Intervention Programs (TIPs) and Encounters.
Methods: The study was conducted
in 2 high-volume grocery store chain
community pharmacies serving a significant portion of OutcomesMTM eligible patients. Implementation of TIPs
into the workflow design was completed
through intern-led training on how to
identify eligible patients, complete reimbursable medication therapy management (MTM) services, and complete
documentation and billing. Chain lead-
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ership accompanied the intern during
training and 40 additional pharmacist
hours for service implementation. The
intern partnered with the pharmacist
manager and staff to provide ongoing
support via phone. The ongoing analysis of this implementation includes:
comparing MTM completion rates for 6
months before and after the training and
an evaluation of revenue generated from
the OutcomesMTM service and costs associated with its operation. This study
was determined exempt from informed
consent by the university’s institutional
review board.
Results: Research in progress. Preliminary results show intern-led implementation, coupled with corporate support, provided the staff with the tools
necessary to begin providing reimbursable MTM services to eligible patients.
Additionally, the pharmacists at both
locations utilized the intern for mentoring and real-time problem solving. MTM
completion rate comparison and financial analysis are ongoing. This project
will provide insight on how an MTM service can be implemented in workflow of
a high-volume grocery store chain community pharmacy.
Q 182—IMPLEMENTATION OF
CLINICAL PHARMACIST IN THE
MEDICAL HOME MODEL. Ball H,
Fort Belvoir Community Hospital, Email: [email protected]
is to assess the impact of a clinical pharmacist on Healthcare Effectiveness Data
and Information Set (HEDIS) measures
when providing disease management
services to the patient-centered medical
home (PCMH) model.
Methods: In this study, 127 diabetic
patients and 130 hyperlipidemia patients
were followed over a 12-month period
by the clinical pharmacist within the
family medicine residency clinic. Disease
management services provided included
medication education, medication adjustments, follow-up lab orders, and
follow-up visits via phone call or clinic
visits. The primary study endpoints
were changes in low-density lipoprotein
(LDL) cholesterol and A1C from baseline
to 15 months.
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Results: Over the 12-month followup period, average A1C levels decreased
from 8.59% to 7.34% (P<0.0001). Average
LDL levels decreased from 111.83 mg/
dL to 90.48 mg/dL (P<0.0001). Average
blood pressure at the end of the study period was <130/80 mmHg.
Conclusion: Implementation of a
clinical pharmacist within the PCMH
model improves HEDIS measures of patients with diabetes and hyperlipidemia.
Original Citation: Joint Forces Abstract #32
183—IMPLEMENTATION OF CLINICAL PHARMACY SERVICE FOR
PREVENTING PRESCRIPTION ERRORS IN A WOMEN’S HEALTH INTENSIVE CARE UNIT. Costa L, Ferracini A, Rodrigues A, Cruz A, Barros A,
Silva N, Carvalho R, Moriel P, University of Campinas, Mazzola P, pmazzola@
fcm.unicamp.br, Department of Clinical
Pathology , E-mail: [email protected]
to evaluate the impact of clinical pharmacy implementation in patient safety
of a specialized women’s health intensive care unit (ICU) through quantification and assessment of the clinical significance of pharmacy interventions and
prescription errors.
Methods: The study was conducted
from February 2012 to February 2013
in the ICU of a university women’s
hospital. The pharmacist analyzed prescriptions of patients >18 years of age,
admitted to ICU for >24 hours and performed interventions during bedside
visits, quantifying and dividing them
into accepted or not by the medical team.
Prevented prescription errors also were
quantified, and clinical significance of
the errors and the interventions were assessed. Drugs most commonly involved
in prevented errors were quantified and
classified by ATC classification. Statistical analysis was performed using the
Fisher exact test to assess the association
between drug classes and clinical significance of errors.
Results: There were 224 patients
monitored (110 obstetrics, 96 oncological, and 18 gynecological); mean age
was 44.4 ± 18.1 years (mean ± standard
deviation). A total of 1,259 prescriptions
APhA2014 ABSTRACTS
were evaluated, in which 104 prescription errors were identified; of these 90
prescription errors were prevented. The
most common prescription errors were
dosage higher than correct (n = 17) and
unsafe medication due to drug interaction (n = 17). Among the 130 interventions performed, 116 were accepted, 4
partially accepted, and 10 not accepted.
The most common were dosage (n = 30)
and drug information (n = 17). Drugs
to digestive tract (n = 43) and nervous
system (n = 20) were the most involved
in the errors. There was statistical association between involved drug classes
and the clinical significance of errors (P
= 0.0359). Most prevented errors were
significant (n = 74) and serious (n = 18);
most of interventions were significant (n
= 67) and somewhat significant (n = 18).
Conclusion: Clinical pharmacy
implementation contributed to patient
safety by preventing prescription errors
and reducing risks from drug therapy.
184—IMPLEMENTATION OF A
MARKETING STRATEGY TO INCREASE PATIENT PARTICIPATION
IN MEDICATION THERAPY MANAGEMENT IN A COMMUNITY SETTING. Kosloski K, Steber S, Charles M,
Simenson S, Goodrich Pharmacy, Email: [email protected]
of this study was to determine whether
implementing a marketing strategy that
focused on increasing patient awareness
and knowledge by providing patients informational packets would increase patient participation in a community medication therapy management (MTM)
practice setting. The secondary objective
was to determine whether the inclusion
of a primary care provider (PCP)–endorsed recruitment letter in the informational packet would further increase
patient participation compared with generic recruitment letters.
Methods: This was a quasi-experimental, randomized, controlled study
with 155 patients targeted for MTM
services at a community-based clinical
pharmacy practice. Informational packets about MTM services, which included
an MTM informational brochure, along
with either a generic recruitment letter or
a PCP-endorsed recruitment letter were
mailed to each patient in the intervention
groups. Recruitment phone calls were
conducted within 14 days of mailings.
The main outcome measure was patient
participation in clinical MTM services.
Results: A total of 155 patients were
enrolled in this study. The control group
had 17% participation in MTM services
(n = 13) compared with 33% participation (n = 26) with the intervention group.
The intervention group had a statistically significant (P = 0.006) 16% increase
in patient participation. There was no
statistical difference between using a
generic recruitment letter versus a PCP
endorsed letter.
Conclusion: Use of a marketing
strategy that included an informational
packet sent to patients resulted in increased patient participation in community MTM. This increase in participation
may be related to the increased awareness that these informational packet conveyed to patients.
185—IMPROVEMENT OF UTILIZATION OF CLINICAL SERVICES IN
COMMUNITY PHARMACY USING
MEDICATION
SYNCHRONIZATION AND THE APPOINTMENTBASED MODEL. Butler S, Stafford R,
University of Arkansas for Medical Sciences, E-mail: [email protected]
study are to: (1) determine the impact of
medication synchronization (MS) and
appointment-based model (ABM) on
revenue from prescription and clinical
sales; and (2) explore the effects of these
models on pharmacists’ workflow, with
the intention of freeing up time to perform more clinical actions such as medication therapy management (MTM) and
immunizations, by measuring the reallocation of time spent per patient on a
monthly basis using company standard
measurements of workflow functions.
Methods: A convenience sample of
10 to 20 patients per pharmacy eligible
for MTM services and ≥18 years of age
will be selected from 2 supermarket
pharmacies. The patient’s medication
profile will be analyzed to determine
the appropriate MS schedule. All medications requested by the patient will be
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synchronized to the specified appointment date. Expected study duration is 4
to 6 months. Objectives will be measured
by comparing the sample’s averages for
6 months prior to the study and during
each month of the study. Descriptive statistics will be used to analyze the data.
Results: Research in progress. Some
pharmacies employ clinical pharmacists,
outside the normal workflow, to provide
clinical services. Demonstrating the impact of utilizing MS and ABM to allow
pharmacists to use time efficiently and
to generate revenue could imply that
clinical services should be included in
normal workflow provided by all community pharmacists. Clinical service
success may increase when the pharmacists providing the services are those
assigned to workflow in the same store
daily, which have a relationship with the
patients, rather than clinical pharmacists
who float to stores as needed. Showing
positive outcomes in this patient sample
could lead to expansion of the models in
more stores where greater results and
further conclusions could be generated.
186—THE INFLUENCE OF COMMUNITY PHARMACISTS ON STAR
RATINGS: FOCUS ON DIABETES
MEDICATION ADHERENCE. Berenbrok L, University of North Carolina at
Chapel Hill Eshelman School of Pharmacy, Michaels N, Lee J, Petri D, Kerr Drug
Inc., Marciniak M, Ferreri S, University
of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected]
Objective: With pay-for-performance models gaining ground in the
United States, the role and impact of
pharmacists on value-based health care
are becoming increasingly important to
patients and to third-party payers. Star
ratings, designed to encourage value by
Services (CMS), guide patient selection
of Medicare Prescription Drug Plans by
rating each plan on quality and performance using a scale of 1 to 5 stars. Plans
may achieve a 5-star rating by meeting
benchmarks for several predetermined
measures of quality. One such measure
that pharmacists can impact is proportion of days covered (PDC) for diabetes
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APhA2014 ABSTRACTS
medications. This study aims to evaluate
to what extent community pharmacists
can impact star ratings by initiating targeted underuse interventions.
includes data obtained from OutcomesMTM documented by pharmacists of a regional pharmacy chain.
Claims billed using OutcomesMTM as
metformin underuse with a status of
approved/paid from January through
December 2012 will be included for
analysis. For each claim identified, the
pharmacy dispensing software will be
utilized to calculate the PDC for each
underuse claim 6 months prior and 6
months following the pharmacist’s intervention. A paired Student t test will
be used to evaluate a change in pre- and
post-intervention PDC for patients underusing metformin to represent a chainwide impact on star ratings.
Results: Research in progress. Institutional review board approval is anticipated in November 2013. Data analysis
will occur December 2013 through January 2014, with results available in March
2014. Preliminary reports indicate that
over 300 claims are eligible for analysis.
187—MEASURING THE IMPACT OF
AN INTERDISCIPLINARY POLYPHARMACY CLINIC WITHIN A
PATIENT-CENTERED
MEDICAL
HOME. LaBella S, Li G, Barnes K, Matthews D, Beatty S, The Ohio State University, E-mail: [email protected]
of this project is to track the types of interventions made in an interdisciplinary polypharmacy clinic to improve
medication regimens and medication
burden. Polypharmacy has been well
documented in the literature as a risk for
medication errors, adverse drug events,
and morbidity. Team visits, including
complete medication reviews, by pharmacists and physicians within a National Committee for Quality Assurance
(NCQA) tier 3 patient-centered medical
home (PCMH) at an academic medical
center, can improve medication regimens. Secondary objectives include: (1)
measuring each patient’s quality of life at
baseline and 1 month post-intervention
and (2) tracking the cost of medication
e144 JAPhA | 5 4:2 | M AR/AP R 2014
additions and discontinuations.
Methods: Patients taking ≥10 chronic
medications will be identified for referral
to the polypharmacy clinic from a report
generated from the electronic medical
record. The polypharmacy clinic will be
staffed by a pharmacist and medical resident with oversight from an attending
physician who specializes in geriatrics.
Drug-related problems identified during the visit will be resolved and categorized based on indication, efficacy, cost,
safety, and compliance. The numbers
and types of interventions made, both
during the primary visit and anticipated
in the future, will be tracked. The 12-item
short form (SF-12) survey also will be administered at baseline and 1 month post
intervention. The increase or decrease in
cost for medications added and removed
during these visits will be captured using
the average wholesale prices.
Results: Research in progress. Using
descriptive statistics, the types of drugrelated problems identified and interventions made will be reported. Changes
in quality of life and monthly medication
costs will be described.
188—PATIENTS’
KNOWLEDGE
AND PERCEIVED VALUE OF A
COMMUNITY PHARMACY MEDICATION
THERAPY
MANAGEMENT PROGRAM. Mobley-Bukstein
W, Ulrich E, Aldrich C, Drake University, E-mail: wendy.mobley-bukstein@
drake.edu
study is to determine patients’ knowledge and perceived value of a community pharmacy–based medication therapy
management (MTM) program.
Methods: This study consists of a
cross-sectional 10-item survey distributed to patients of 15 franchise community pharmacy locations, owned by a
single company, in a large Midwestern
city. Individuals who are eligible to receive MTM services were included in
this study; patients must be diagnosed
with ≥5 comorbidities and/or taking
≥10 prescription medications. A computer-generated random sample of 100
subjects was created from the pool of all
patients who meet this requirement from
all 15 pharmacies. An online survey was
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sent to those subjects who had an e-mail
address and a paper copy of the survey
was mailed to those without an e-mail
address. Measures of interest include:
demographics, type of prescription drug
coverage, awareness of MTM service being offered at the pharmacy, perceived
value of an MTM service, willingness to
pay for an MTM service, and preference
of setting to receive an MTM service. After 2 weeks, follow-up postcard and/or
phone call reminders were conducted.
The survey respondents were given 4
weeks to respond. At this time, data are
being collected. Descriptives and frequencies will be conducted for all survey
items. Chi-square and Spearman correlations will be conducted to determine
the relationships between subjects’ perceived value of an MTM service, willingness to pay, preferred setting to receive
an MTM service, and demographic and
type of prescription drug coverage.
These analyses may characterize different subgroups of patients. It is expected
that there will be a correlation between
patients who perceive value in the MTM
service and patients who are willing to
pay for an MTM service.
Results: Research in progress. There
are no results available because the survey is still active.
189—PHARMACOTHERAPY AND
MANAGEMENT
OF
ASTHMA
AMONG CHILDREN AND YOUNG
ADULTS IN AN OFFICE-BASED
AMBULATORY CARE SETTING.
Lam A, Rhiel T, Maneno M, Howard
[email protected]
study was to evaluate the pharmacotherapy and management of asthma among
children and young adults in an officebased ambulatory care setting.
Methods: A cross-sectional study of
ambulatory care visits in the National
Ambulatory Care Survey from 2000 to
2010 was conducted. Included in this
study were patient visits of persons who
were ≤17 years of age with an associated
International Classification of Diseases–
9th revision diagnosis of asthma. Descriptive statistics including means and
frequency distributions were estimated
APhA2014 ABSTRACTS
for patient characteristics and types of
asthma related therapy. Trends in asthma-related therapy and asthma education before and after the 2007 Expert
Panel Report 3 (EPR3) were evaluated
using the chi-square test. All analyses in
this study were conducted using SPSS
version 19 at an alpha of 0.05.
Results: There were 1,970 visits from
persons ≤17 years of age included in the
study. The majority were male (60.7%),
white (76.5%), and managed by pediatricians (71.9%). Overall, short-acting betaagonists (SABA) were the most common
asthma-related therapy prescribed for
those aged 0 to 4 years (67.4%), 5 to 11
years (63.8%), and 12 to 17 years (62.8%).
Leukotriene modifiers were more frequently prescribed among those aged
5 to 11 years (25.7%) and those aged 12
to 17 years (20.0%) versus those aged 0
to 4 years (15%). Overall, asthma education decreased from 53.3% before 2007 to
41.2% after 2007 guidelines (P<0.05). Prescribing differences before 2007 and after
2007 guidelines were noted for long-acting beta-agonists(LABA)/inhaled glucocorticoids combination therapy products, with increases observed among visits of those aged 0 to 4 years, 5 to 11 years,
and 12 to 17 years (P<0.05). Few visits
were associated with LABA alone across
all age groups after 2007 (<1%).
Conclusion: This study shows
changes in prescription drug asthmarelated therapy, with fewer LABA-only
regimens which shows adherence to
EPR3 guidelines. Decrease in asthma
education shows need for improvement.
therapy management (MTM) communication in the community pharmacy setting; (2) identify physicians’ perceived
barriers to communicating with a pharmacist regarding MTM; and (3) determine whether Missouri physicians believe MTM is beneficial for their patients.
Methods: A cross-sectional, prospective survey study will be conducted
using mail-in surveys. Surveys will be
mailed on January 2, 2014 and responses
accepted until March 1, 2014. The survey
contains items that address physicians’
experience with MTM, physicians’ preferences regarding MTM communication,
physicians’ perceived barriers to communicating with pharmacists regarding
MTM, and whether or not physicians believe that MTM is beneficial for their patients. The survey also will collect the following demographic data: sex, age, years
in practice, and practice specialty. All
questions are multiple-choice, yes/no,
or short-answer format. All survey responses will be anonymous. Physicians’
mailing addresses will be obtained from
the MO HealthNet provider listing. Surveys will be mailed to the 2,576 general
and family practice physicians registered
with MO HealthNet. Included in each
mailing will be a 1-page introduction letter, a 1-page survey, and a postage-paid
business reply envelope. Descriptive statistics will be used to analyze the demographic information. Nominal data will
be evaluated utilizing chi-square analysis. Data points will be analyzed using
the SPSS statistical software program.
190—PHYSICIANS’ PREFERENCES
FOR COMMUNICATION REGARDING
PHARMACIST-PROVIDED
MEDICATION THERAPY MANAGEMENT IN THE COMMUNITY
PHARMACY SETTING. Shackles K,
Stoner S, University of Missouri–Kansas City School of Pharmacy, Hartwig
D, May J, Nicolaus S, Schramm A, Red
Cross Pharmacy Inc., DiDonato K, University of Missouri–Kansas City School
of Pharmacy, E-mail: shacklesk@umkc.
edu
identify physicians’ preferences regarding pharmacist-provided medication
191—A RETROSPECTIVE ANALYSIS
ON THE IMPACT OF A STUDENT
PHARMACIST–RUN
TARGETED
INTERVENTION PROGRAM. Melody K, Shah C, Patel J, Willey V, University of the Sciences, E-mail: k.melody@
usciences.edu
is to evaluate the impact of a student
pharmacist–run targeted intervention
program.
Methods: OutcomesMTM connects
insurance companies with local pharmacies to provide medication therapy
management. One of these services is a
targeted intervention program (TIP), re-
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quiring a physician consultation (needs
additional therapy and cost efficacy) or
a patient consultation (underuse, new
therapy monitoring, and administration/technique) to resolve. Beginning in
August 2013, a new model was started in
which student pharmacists work under
the supervision of a pharmacist to resolve TIPs. In this retrospective analysis,
data from August 1, 2013 to December
31, 2013 will be examined from a report
of TIPs claims generated from OutcomesMTM and pharmacy records. The
impact of this model will be evaluated
using descriptive analysis techniques
such as means, standard deviations, medians, frequencies, and percentiles of the
TIPs regarding reimbursement, estimated cost avoidances (ECA), patient satisfaction, TIP acceptance rates, and types
of TIPs completed. Reimbursement and
ECA rates are set by OutcomesMTM. Patient satisfaction is obtained using a Likert scale during patient follow-up.
Results: Out of 159 total TIPs available, 31 (19.5%) have been attempted
and 10 (6%) have been completed (3 accepted, 6 rejected, 1 invalid). Based on
preliminary data, reimbursement for the
completed tips was $83 and students and
pharmacists spent a total of 84 minutes
and 2 minutes, respectively, completing
these TIPs, earning the pharmacy $59/
hour. Two of the accepted TIPs were
needs additional therapy and the third
was new therapy monitoring. The ECAs
for the accepted TIPs submitted included
a hospitalization, an emergency room
visit, and adherence support, which
totaled approximately $27,050. Preliminary data show that this is a successful
and innovative model to complete TIPs
that could be implemented in other community pharmacies to improve patient
outcomes, lower health care costs for
patient, and increase revenue in a costeffective way for the provider of these
services.
192—RETURN ON INVESTMENT
OF USING PHARMACY TECHNICIANS TO AID IN THE COMPLETION OF COMPREHENSIVE MEDICATION REVIEWS. Stafford R, University of Arkansas for Medical Sciences
College of Pharmacy, E-mail: rastafMA R /APR 2014 | 54:2 |
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APhA2014 ABSTRACTS
[email protected]
Objective: This study aims to determine the return on investment of using
a technician to perform the nonprofessional tasks needed to complete comprehensive medication reviews (CMRs)
for medication therapy management
(MTM) services.
Methods: A pharmacy technician at
a supermarket pharmacy was trained on
the OutcomesMTM platform to identify
eligible patients, schedule CMR appointments, and enter medication lists. Ten
hours per week were earmarked for the
technician to perform duties related to
MTM for 6 weeks. A report was generated to determine the number and types
of claims billed and refused and fees collected.
Results: During the project, 89
claims generated fees of $2,454. Twentyseven claims were for a completed CMR
visit; 1 claim was a CMR refusal. The
remaining 61 claims were intervention
claims resulting from a CMR. On average, $91 fees were collected per CMR performed. This does not include additional
claims that were still pending follow-up
at the time of abstract submission. For
each hour of technician time invested,
$40.90 of MTM fees were collected.
Conclusion: Using technicians to
complete nonprofessional tasks related
to MTM can increase the number of successful CMRs completed, decrease refusal rates, and further streamline pharmacists’ time. For pharmacies implementing MTM services or for pharmacies that
already provide MTM services, it is crucial to include technicians in the MTM
workflow.
193—STUDENT PHARMACIST IMPACT ON MEDICATION THERAPY
MANAGEMENT SERVICES IN A
HIGH-VOLUME
COMMUNITY
PHARMACY. Hestin J, Greco A, McConaha J, Duquesne University, E-mail:
[email protected]
is to determine the success of incorporating student pharmacists into the
implementation of medication therapy
management (MTM) programs within
a high-volume community pharmacy
by evaluating the types of MTM inter-
e146 JAPhA | 5 4:2 | M AR/AP R 2014
ventions performed, MTM completion
rates, and the amount of revenue generated. MTM platforms, such as Outcomes
and SOCRxATES, allow pharmacists to
conduct complete medication reviews
(CMRs), targeted intervention programs
(TIPs), and gap-in-care alerts. However,
lack of pharmacist time, insufficient staffing, and high prescription volume make
incorporating these MTM programs into
workflow a challenging task. Student
pharmacists can help alleviate these barriers by completing the preparation and
follow-up components of MTM and by
assisting pharmacists during the patient
consultation. The goal of this study is to
assess the effectiveness of incorporating
student pharmacists into the MTM process of a high-volume community pharmacy by determining the overall MTM
completion rates and generated revenue.
will pilot 2 MTM platforms in 4 highvolume community pharmacies. These
locations will have a lead student pharmacist and pharmacist managing the
MTM services. The student pharmacists
will assist with calling and scheduling
patients for the MTM consultation, completing the consultation preparation, and
documenting the intervention. The pharmacists will conduct the consultation interviews and submit for billing. Specific
data that will be collected includes the
number of CMRs, TIPs, and gap-in-care
alerts completed (completion rate), and
the total amount of revenue generated
from these MTM services. Data will be
collected for 3 months and compared
with the previous completion rates and
generated revenue for the 3 months prior
to incorporating student pharmacists. Increased completion rates and generated
revenue will indicate the success of incorporating student pharmacists into the
MTM process. Institutional review board
approval has been granted.
194—TARGETING
TRANSITION
IN CARE PATIENTS IN A COMMUNITY PHARMACY TO DECREASE
HOSPITAL READMISSION RATES.
Neltner A, Kroger Pharmacy Cincinnati–Dayton KMA, Luder H, University
of Cincinnati, Frede S, Pleiman M, Rosser
ja p h a .org
S, Kroger Pharmacy Cincinnati–Dayton KMA, E-mail: shelly.rosser@stores.
kroger.com
to implement a systematic approach in a
community pharmacy that targets transition in care patients post hospital discharge to measure 30-day hospital readmission rates, participation, pharmacist
interventions, and patient satisfaction.
Methods: Pharmacists impact care
transitions, however it is unknown if
identifying patients post hospital discharge at the community pharmacy decreases hospital readmission rates and
further improves transitional care in
the outpatient setting. This prospective
study will take place at 2 locations of a
large grocery store chain pharmacy in
Cincinnati, Ohio. Inclusion criteria are
English-speaking patients >18 years of
age who have been hospitalized within
the past 10 days. Transition in care patients will be targeted at prescription
drop off by pharmacy technicians who
will ask a standardized question assessing recent hospitalization. Patients
who meet the inclusion criteria will
have a transition in care comprehensive
medication review (CMR) explained
and offered to them by a pharmacist. If
the patient agrees, a face-to-face or telephonic CMR will be conducted by a
pharmacist within 10 days from hospital
discharge as appropriate. If the patient
declines, baseline data will be collected
and will serve as the control group. All
eligible patients will be provided with a
calendar that projects 30 days past their
most recent hospital discharge and will
be educated to document any days they
are readmitted to the hospital. Follow-up
will be completed 30 days post discharge
to determine whether the patients have
been readmitted by assessing their calendars. Hospital readmission data from
the patients who received the CMR will
be compared with patients who declined
a CMR. For those who received a CMR,
the acceptance and success of pharmacist
interventions will be assessed and a satisfaction survey will be administered at
follow-up.
195—UTILIZATION
OF
PHAR-
APhA2014 ABSTRACTS
MACY INTERNS AND AUXILIARY
STAFF IN PROVIDING MEDICATION THERAPY MANAGEMENT
SERVICES. Avena-Woods C, Mantione
M, St. John’s University, E-mail: avenac@
stjohns.edu
survey is to identify how pharmacists
providing medication therapy management (MTM) services are utilizing the
assistance of interns and auxiliary staff.
Results will be used to identify best practices and major challenges affecting a
pharmacist’s success in providing MTM.
This information will help identify focus
areas for training and ways to best support pharmacists providing MTM.
Methods: In collaboration with OutcomesMTM, a survey link was e-mailed
to a randomized group of pharmacists
enrolled as providers in their system.
Pharmacists answer a series of questions
related to their practice setting, characteristics of their MTM provision, allocation of their time during MTM consults,
and utilization of auxiliary staff such as
pharmacy technicians and student pharmacists. Data are being collected regarding how auxiliary staff is being used in
each step of the MTM process as well as
challenges and opinions on future needs
for increased support. Descriptive statistics will be provided.
date, 90 responses have been collected.
The survey link will remain active until the end of 2013, and several other
rounds of pharmacists will receive the
link and request prior to that date. Of
the responses collected so far, the majority of respondents practice in a chain
or independent community pharmacy
and they process 500 to 2,000 prescription per week. Ninety-four percent of
respondents provide MTM services in a
location where they are also responsible
for dispensing prescriptions. Forty-five
percent report having 1 to 5 hours per
week designated by their employer to
perform MTM consults exclusively, but
44% report not receiving any time to devote solely to MTM. Sixty-seven percent
state that the time required to provide
the MTM service is the most significant
barrier, followed by inadequate access
to patient information. The majority of
pharmacists (>90% in each category) report that they are solely responsible for
tasks such as offering MTM, scheduling
patients, and follow-up visits and that
they strongly agree with statements indicating they would be more successful
in providing MTM consults with more
assistance from interns and technicians.
196—UTILIZATION
OF
STANDARDIZED OPERATING PROCEDURES IN IMPLEMENTATION OF
A MEDICATION THERAPY MANAGEMENT PLATFORM. Bateman M,
Greco A, McConaha J, Duquesne University, DeJames J, Krasnow D, Giant
Eagle Pharmacy, E-mail: batemanm@
duq.edu
study are to evaluate the impact and
pharmacist receptivity of standardized
operating procedures (SOPs) when implementing a new medication therapy
management (MTM) platform in highvolume, grocery store pharmacies.
Methods: The pharmacies in this
study follow a structured work design
and require specific SOPs, allowing for
high volumes of prescriptions to be filled
daily. This model is successful for driving distributive pharmacy services, but
creates a challenge when attempting
to incorporate clinical services such as
MTM. SOCRxATES is an MTM platform
recently adopted by the study pharmacies and focuses on addressing adherence and omission gaps in care. SOPs
may support the study pharmacies in
implementing this program properly
and efficiently. This project will use a
mixed-methods, observational, prospective design. At least 5 pharmacies that
dispense >300 prescriptions each day
and have ≥20 SOCRxATES gap in care
alerts prior to the start of this project will
be included. The SOPs will be created by
the study investigators to assist pharmacists in utilizing SOCRxATES to address
the adherence and omission gap in care
alerts. Quantitative data that will be
measured include the percentage of gaps
completed and the counseling revenue
earned. Pharmacist feedback of the SOPs
will be collected and analyzed as qualitative data.
j apha.org
data will help to improve the implementation of future MTM platforms in highvolume, grocery store pharmacies.
Nuclear Pharmacy
197—ANALYSIS OF RADIOPHARMACEUTICAL KIT BASED COMPOUNDING USING 68GA SUPPLIED
BY A 68GE/ 68GA GENERATOR IN A
NUCLEAR PHARMACY SETTING.
January S, Galbraith W, University of
Oklahoma College of Pharmacy, E-mail:
[email protected]
Objective: Current positron emission tomography (PET) radioisotopes
must be produced in a cyclotron causing
the availability of PET imaging agents
to be limited by the proximity of the
cyclotron to the imaging facility. The
68
Ge/68Ga generator provides a PET radioisotope within a nuclear pharmacy
or imaging facility and has the potential
to expand PET imaging as a whole. The
overall objective of this study is to analyze the adaptability of a 68Ge/68Ga generator to a nuclear pharmacy practice setting. Analysis will include 4 parameters:
preparation of eluate, kit compounding,
cost effectiveness, and radiation safety
issues.
Methods: The study is taking place
in a nuclear pharmacy working with a researcher utilizing a 68Ge/68Ga generator.
The concentration and radionuclide purity of the 68Ga eluate using highest fraction elution method is being compared
with that of the eluate using a cation exchange cartridge. The steps required for
labeling 68Ga compounds in current clinical trials will be reviewed. Cost analysis
will include elution processing and efficiency, as well as a comparison between
68
Ga-DOTATOC and 111In pentetreotide.
Since DOTATOC and pentetreotide are
used for the same indication, a comparison will provide relative cost effectiveness of a 68Ga labeled compound. Radiation exposure will be measured during
generator setup and elution processing.
Currently, the commercially available
68
Ge/68Ga generators are not yet approved by the Food and Drug Administration. The cartridge preparation
appears to offer a way to buffer the eluMA R /APR 2014 | 54:2 |
JAPhA e147
APhA2014 ABSTRACTS
ate, minimizing exposure during eluate
processing. Radiolabeling for most 68Ga
compounds is a single-step method. The
end product testing includes solvent impurity testing with gas chromatography
and 68Ge breakthrough testing. Due to
elution yield and half-life, each elution is
able to produce 1 patient dose. Preliminary work delineates the needed modifications, expenses, and identifies barriers
to using a 68Ge/68Ga generator within a
nuclear pharmacy. Findings during this
simulation process will be valuable in
assessing the utility of 68Ga as a viable
delivery method of PET radiopharmaceuticals for patient care, ahead of the anticipated approval of a pharmaceutical
grade 68Ge/68Ga generator.
198—ASSESSMENT OF TECHNETIUM-99M SUCCIMER RESIDUAL
ACTIVITY USING INERT NONREACTIVE SYRINGE. Chen X, Galbraith
W, University of Oklahoma, Talley K,
University of Oklahoma Medical Center,
Grantham V, University of Oklahoma, Email: [email protected]
Objective: It has been widely reported that technetium-99m (Tc99m)
succimer adsorbs to plastic syringes significantly (up to 50%), often resulting in
a lower administered dose than intended
or inaccurate dosing. This is especially
problematic in the pediatric population.
To improve Tc99m succimer dosing,
this study compared the adsorption of
Tc99m succimer with 2 types of syringes:
silicone-coated syringes with non-latex
rubber on the plunger, and inert nonreactive syringes with no silicone coating
and no rubber on the plunger.
Methods: Tc99m succimer kits were
compounded according to manufacturer’s instructions. A series of Tc99m
succimer doses (0.03–0.14 MBq) were
drawn into 3-mL (silicone-coated or inert
nonreactive) syringes in 1 mL volume.
Thirty minutes, 1 hour, 2 hours, and 4
hours later, the syringes were assayed in
a dose calibrator, and assayed again after
being emptied and rinsed with saline. In
addition, the data collected were examined from 129 Tc99m succimer doses
administered in a pediatric department,
in which 52 were dispensed in siliconecoated syringes and 77 were dispensed
e148 JAPhA | 5 4:2 | M AR/AP R 2014
in inert nonreactive syringes. The doses
were assayed immediately before and
after injection followed by flushing with
saline.
Results: The labeling efficiency of
the Tc99m succimer kits was more than
95%. Residual activity left in the inert
nonreactive syringes was 0.73% (standard deviation [SD] ± 0.18%), which is
significantly lower than the activity left in
the silicone-coated syringes (P<0.0001),
which was 20.9% (SD ± 5.6%). The extent
of adsorption did not change significantly between 30 minutes and 4 hours
of incubation. The clinical data showed
that the residual activity was 30.6% (SD ±
12.5%) from doses dispensed in siliconecoated syringes and 6.38% (SD ± 2.95%)
from doses dispensed in inert nonreactive syringes (P<0.001).
Conclusion: The inert nonreactive
syringes retained less than 1% of the activity of the Tc99m succimer, making it
possible to accurately administer desired
doses to pediatric patients.
199—MODIFIED METHOD FOR
ADMINISTRATION OF LU-177 PEPTIDE. Ponto J, University of Iowa, Smith
J, Bricker J, University of Iowa Hospitals and Clinics, E-mail: james-ponto@
uiowa.edu
Objective: Peptides radiolabeled
with lutetium Lu-177 are being used investigationally to treat receptor-expressing tumors. Previous investigators have
used the Flebo infusion method or the
Rotterdam method for administration of
the radiopharmaceutical. The objective
of this study was to establish a modified
administration method that is simple
and efficient, while also affording a high
level of radiation protection.
Methods: An old generator elution
lead vial shield was repurposed to hold
the 30 mL glass vial containing the radiopharmaceutical and an old chemistry
ring stand flask clamp was repurposed
to secure the vial/shield assembly to an
intravenous (IV) pole. The radiopharmaceutical vial septum was punctured with
a vented IV spike infusion set, attached
upside down to an IV pole, and the contents infused with an IV pump.
Results: Unlike the Flebo method,
the method used in this study allowed
ja p h a .org
efficient infusion of the radiopharmaceutical without being diluted with normal
saline. Unlike the Rotterdam method,
this study used a lead vial shield to provide radiation protection. The dose-rate
from 200 mCi Lu-177 unshielded is 5.6
mrem/hour at 1 meter; placed into the
8 mm lead vial shield (~13 half-value
layers), the dose-rate at 1 meter was undetectable. Using the IV spike infusion
set, nearly all of the radiopharmaceutical (initial volume of 23–25 mL) was
removed from the vial. The mean ± SD
volume remaining in the vial was 0.42 ±
0.5 mL, or 1.7% ± 0.2%. This small fractional retention is acceptable within the
protocol and regulatory allowances, and
hence avoids the need for flushing of the
vial to rinse out residual contents.
Conclusion: This modified method
for administration of Lu-177 peptide
allows simple and efficient infusion of
radiopharmaceutical while providing
desired radiation protection.
200—PRACTICE
EXPERIENCE
WITH THE FIRST FOOD AND
DRUG
ADMINISTRATION–APPROVED ALPHA-EMITTING RADIOPHARMACEUTICAL. Tan X,
Galbraith W, University of Oklahoma
College of Pharmacy, Ponto J, University of Iowa College of Pharmacy, E-mail:
[email protected]
Objective: The objective of this project is to describe the implementation of
radium-223 dichloride therapy in a hospital setting.
Methods: A review of the process
involving radium-223 dichloride, an alpha-emitting radiopharmaceutical, was
conducted. Therapy was administered
at an academic hospital with a patient
population that fit the treatment parameters. Data were collected from interviews with the pharmacist participating
in therapy management. Survey questions ranged from the steps required to
bring the radiopharmaceutical into the
hospital formulary to administering the
dose to patients. Data were then assessed
for the ease of implementation to other
facilities.
Results: From August 2013 to October 2013, radium-223 dichloride has been
administered to 10 male patients aged
APhA2014 ABSTRACTS
57 to 90 years. To date, 4 patients have
completed the first cycle of treatment, 3
patients have completed second cycle,
and 3 patients have completed the third
cycle. Barriers such as proper facility licensing, verification of the compounding pharmacy, therapeutic necessity,
and medication reimbursement were
found. One such example is that the drug
is manufactured in a vial, but dispensed
from a pharmacy in a unit-dose syringe
from 1 location in the United States. This
combines the process of assuring the
pharmacy compounding status from 2
boards of pharmacy. The facility’s standard operating procedures (SOP) for the
alpha radiopharmaceutical were developed. SOPs included communication
with oncology throughout the 6-month
treatment cycle, nuclear medicine department’s modification of radiopharmaceutical delivery schedule from an
out of state pharmacy, syringe assay
when patient dose was provided in more
than one 10-mL syringe, dose calibrator
accuracy when verifying the administered dose, contamination detection
efficiencies, and decontamination procedures. Product was added to the formulary after providing these additional
supporting documents to the Pharmacy
and Therapeutics Committee.
Conclusion: Similar procedures can
be adapted by other facilities with a patient population that will benefit from
radium-223 dichloride treatment.
OTC, Self-Care, and CAM
201—ASSESSING THE ROLE OF A
PHARMACIST ON THE SELECTION
AND KNOWLEDGE OF NONPRESCRIPTION MEDICATIONS PROVIDED TO PATIENTS THROUGH
POINT-OF-CARE
CONSULTATIONS. Patel P, Walgreens/Massachusetts College of Pharmacy and Health
Sciences University-Boston, Machado
M, Mistry A, Massachusetts College of
Pharmacy and Health Sciences University, E-mail: [email protected]
this study is to assess the role a pharmacist plays on the selection of nonprescription medications during a point-of-care
consultation. The secondary objective
is to assess the patient’s knowledge on
the specific nonprescription medication.
As the role of a pharmacist has evolved
in the past decade, it is a pharmacist’s
responsibility to educate and counsel
patients regarding not only prescription
medications but also nonprescription
medications. Having the most direct
relationship with their patients, community pharmacists have the potential
to make a dramatic difference in their
patients’ overall health status.
approval. The point-of-care service will
occur in 2 community pharmacies within
the same community chain in Massachusetts. Patients for inclusion in the study
will be individuals found in the front
store viewing any nonprescription medication including over-the-counter products, herbal and dietary supplements;
patients who present themselves to the
patient consultation room or the dropoff, pick-up, and pharmacy consultation
windows at the pharmacy; and patients
eligible for medication therapy management services. A thorough consultation
will include collecting information on a
patient’s age, sex, allergies, current disease states and medications, as well as
chief complaint after informed consent
is documented. Additional information
such as a patient’s current knowledge of
the selected product’s active ingredients,
warnings, side effects, and directions for
use will be gathered. All data will be recorded without patient identifiers and
confidentiality will be maintained. Data
from each patient will be evaluated to
be included in the study’s descriptive
analysis. The reviewers will assess how
many patients were receptive to a pharmacist’s consultation, how many interventions were made, how many patients
changed their intended purchases after
the consultation, and how many patients
did or did not have previous knowledge
of their intended purchase.
Q 202—A CONSUMER SURVEY OF
HERBAL PRODUCT AND DIETARY
SUPPLEMENT AWARENESS IN
IDAHO. Toone T, Owens C, Steed M,
Idaho State University, E-mail: ctow-
j apha.org
[email protected]
is to assess consumers’ knowledge, practices, and attitudes regarding herbal
products and dietary supplements.
Although used by millions of Americans, several potential safety concerns
have been noted with these products,
including misconceptions on the part of
consumers, potential for adverse effects
and/or supplement-drug interactions,
and a lack of consistent efficacy data
from randomized, controlled clinical trials.
Methods: The university’s institutional review board approved this
survey. A convenience sample of adult
Idaho residents who reported use of an
herbal product or dietary supplement
for a health-related reason in the past
year were asked to complete a brief, paper survey at local pharmacies, gyms,
and community events. The survey included demographic information and
assessed type and frequency of herbal
product and dietary supplement use. A
5-point Likert scale was used (0 = strongly disagree; 5 = strongly agree) to assess
attitudes related to perceived safety and
efficacy of these products. Concomitant prescription and over-the-counter
(OTC) medication use also was queried.
Respondents were asked about their familiarity with the Dietary Supplement
Health and Education Act and the role
of the United States Pharmacopeia and
Consumer Lab in testing these products.
Results: A total of 526 surveys were
completed and analyzed. The majority
of respondents (71.5%) preferred dietary
supplements over prescription or OTC
medications for treating disease or maintaining health. Most respondents agreed
that dietary supplements could interact
with prescription medication (Likert
scale score 3.94); there was somewhat
less agreement that these products have
the potential for adverse effects (average
score 3.39).
Conclusion: Herbal products and dietary supplements are commonly taken
on a daily basis concomitantly with prescription medication and patients may
underestimate the potential for adverse
effects. Clinicians should regularly assess use of these products and provide
MA R /APR 2014 | 54:2 |
JAPhA e149
APhA2014 ABSTRACTS
education regarding risks and benefits,
including the potential for adverse effects and interactions.
Original Citation: Poster previously presented at: Idaho State University
Research Day, Idaho State University;
ISHP-Local State Chapter, Sun Valley,
ID; ASHP Midyear Clinical Meeting, Orlando, FL.
203—EVALUATION OF STUDENT
SELF-CARE CONFIDENCE IN TWO
TEAM-BASED LEARNING FORMATS. Todt A, Kiersma M, Manchester
University, Frame T, Chen A, Gryka R,
Cailor S, Cedarville University, E-mail:
[email protected]
was to evaluate student perceptions and
confidence of self-care concepts using a
team-based learning (TBL) format at 2
universities.
Methods: TBL has been increasingly
utilized in higher education because active learning aids in promoting self-directed learning and adaptability in problem-solving situations while improving
student performance and increasing
active learning time. A 32-item instrument was administered at the beginning
and conclusion of a self-care course at 2
universities. The instrument examined
student perceptions of self-care utilizing the theory of planned behavior (TPB)
domains of perceived behavioral control,
subjective norm, and attitude (13 questions, 7-point, Likert-type, [1 = strongly
agree; 7 = strongly disagree]), and confidence in learning self-care concepts using Bandura’s Social Cognitive Theory
(19 questions, 5-point, Likert-type, “not
at all confident” to “extremely confident”). Pre- and post-assessments were
evaluated using paired t tests and differences between universities using independent t tests since the data were normally distributed. Instrument reliability
was measured using Cronbach alpha.
Results: A total of 117 students were
assigned to TBL teams. Cedarville (N =
53, 100% response) and Manchester (N
= 58, 92% response) students completed
both instruments. Student self-care perceptions with TPB improved significantly on 8 of 13 questions for Cedarville
(P<0.05) and 1 of 13 questions for Man-
e150 JAPhA | 5 4:2 | M AR/AP R 2014
chester (P<0.05). Student confidence in
learning self-care concepts improved
significantly on all questions for both
universities (P<0.001). Combined analyses of both schools showed significant
results on 5 of 13 perceptions and all 19
confidence questions (P<0.05). Scale
reliability indicated the instrument subscales (TPB and confidence) were reliable
measures of student intention regarding
learning and utilization of self-care concepts (alpha >0.8, respectively).
Conclusion: Data indicate TBL was
effective in improving student confidence in self-care concepts. Since pharmacists must utilize self-directed learning to continually expand their knowledge of pharmacy and be adaptable in
problem-solving situations, it is important to establish these skill sets prior to
entering the profession.
204—FACTORS
INFLUENCING
COMMUNITY
PHARMACISTS’
OVER-THE-COUNTER ORAL ANALGESIC DRUG RECOMMENDATIONS FOR PATIENTS. Kanani K, Volino L, Rutgers University, Patel V, Bayer
HealthCare, Toscani M, Rutgers University, E-mail: [email protected]
study is to assess potential factors influencing pharmacists’ decisions to select
and/or recommend over-the-counter
(OTC) systemic analgesic drug products
in the United States. One of the major
roles of a community pharmacist in providing patient-focused care is as a selfcare consultant. As self-care consultants,
community-based pharmacists interface
with patients requesting health information, which includes assisting patients
in selecting OTC products, counseling,
and addressing health-related questions.
However, little research has been done
on factors that influence OTC drug product recommendations by the pharmacist.
Methods: A 20-question online survey assessing potential factors influencing pharmacists’ decisions to select and/
or recommend OTC systemic analgesics
will be distributed to approximately
3,100 community pharmacists in all
regions throughout the United States.
Pharmacists will be selected via a database maintained by a market research
ja p h a .org
organization and encompasses various
practice types (i.e., independent, chain/
mass merchandiser, and grocery store)
and areas (i.e., urban, rural, and suburban). The sample size represents the
maximum number of community practicing pharmacists maintained in the
database. A response rate of 20% to 30%
is expected based on market research
reports. Survey questions will evaluate
forces such as medical (e.g., primary and
secondary literature, pharmacy school
instruction, product safety profile), social (e.g., personal, patient, colleague,
and health care professional feedback;
product cost) and marketing (e.g., television, Internet, mail, and store advertising; brand reputation). In addition, area
and number of years of practice will be
collected. The survey instrument was
developed based on comprehensive literature review and professional expertise and is not validated. Factors will be
analyzed individually using overall and
subgroup analysis. Only descriptive statistics including frequencies and mean
scores will be used to analyze data and
identify trends. An application for exemption from full institutional review
board was submitted and is pending approval.
205—FACTORS
INFLUENCING
CONSUMERS
TO
PURCHASE
OVER-THE-COUNTER DRUGS IN
AMERICAN SAMOA. Amoa F, Daniel
K. Inouye College of Pharmacy University of Hawaii at Hilo, Tufa A, University
of Hawaii at Manoa, Ma C, Wongwiwatthananukit S, Daniel K. Inouye College
of Pharmacy University of Hawaii at
Hilo, E-mail: [email protected]
Objective: American Samoa is a U.S.
territory with a population of 55,000.
There are currently only 2 U.S. registered
pharmacists working in the hospital and
none available in retail pharmacies. With
the growing number of over-the-counter
(OTC) drugs being sold in local grocery
stores, the objective of the study was to
determine factors that influence consumers to purchase OTC drugs.
Methods: A convenience sample
of 350 participants aged ≥18 years with
prior OTC purchase and use for ≥3
APhA2014 ABSTRACTS
months were recruited from 6 different
public locations across Tutuila island. A
cross-sectional face-to-face survey with
structured interview questions was developed and conducted by well-trained
interviewers to gather sociodemographic information, OTC use, knowledge
of effectiveness and safety, and factors
influencing utilization of OTC drugs.
Data were analyzed using descriptive
statistics.
Results: Of the 350 people surveyed,
325 surveys were completed and usable (60% women, 40% men; age range
18 to ≥60 years). Local grocery stores
were the main source to purchase OTC
drugs (51%). Familiarity with brand
name, perceived effectiveness, safety,
and minor sickness were major factors
related to purchasing decision (≥62% of
participants responding “very often” or
“always”). The majority of participants
(68%) reported that knowledge of effectiveness was based on previous use and
they knew what OTC drug to buy by
reading the label. Purchasing OTC drugs
for others in the household was reported
by 75% of participants and 87% would
ask a pharmacist when a pharmacist was
available to offer an opinion at the time
the participant was purchasing OTC
drugs.
Conclusion: Results indicate several
factors influence consumers to purchase
OTC drugs. Although participants reported reading the label when deciding
to purchase, previous use and familiarity
with brand name and/or minor sickness
were more influential. Results suggest an
opportunity for pharmacist involvement
in expanding roles and counseling services to stores that sell OTC drugs.
206—HERBAL MEDICATION USE
IN THE GUJARATI POPULATION
AND ITS IMPACT ON MEDICATION COMPLIANCE. Patel Y, Hilas
O, St. John’s University, E-mail: yesha.
[email protected]
study is to: (1) identify cultural beliefs
and influences contributing to the use
of Ayurvedic practices; (2) observe a
change in perception between early and
recent immigrants in the use of Ayurveda; and (3) determine if noncompliance
exists secondary to the use of Ayurveda.
Methods: A qualitative study design was conducted using focus groups
organized in Gujarati-dense locations
at a community center in New York
predominantly consisting of the firstwave immigrants (1970s), and a temple
in New Jersey predominately consisting of recent immigrants (1990–2000s).
Participants were recruited from the
community center by word of mouth
and participants from the temple were
recruited by the use of a suggested representative sample. Participants were
required to have prior or current experience with Ayurveda, be ≥18 years of age,
and Gujarati. Discussions were carried
out in native language, tape recorded,
transcribed, and analyzed. Participants
were asked various questions to gauge
perceptions and use of Ayurvedic medicine. A literature search was performed
for articles studying the Gujarati population and Ayurveda. Currently, no analyses of medication compliance and use
of Ayurvedic practices in the Gujarati
population have been performed.
Results: The literature review consisted of 2 relevant articles. The first
study indicated 63.2% of Asian Indians
utilize complementary and alternative
medicine. The second study suggested
that 20% of the Gujarati population reported using traditional medicine. Both
groups agreed, Ayurveda along with
diet and lifestyle modifications aided in
prevention or cure of disease states. A
difference in perception of Ayurvedic
practices was observed between early
and recent immigrants. The study population is likely to use Ayurvedic medicine resulting in noncompliance to prescription medications.
Conclusion: The implications and
extent of Ayurvedic practices in the
Gujarati population is unknown and
requires further study. A better understanding may aid in counseling and educating patients in medication management.
207—PHARMACIST
INTERVENTION IN PATIENT SELECTION OF
SELF-CARE PRODUCTS. Schimmelfing J, Virginia Commonwealth University, Brookhart A, Fountain K, The Kroger
j apha.org
Co., Goode J, Virginia Commonwealth
University, E-mail: schimmelfinjt@vcu.
edu
is to: (1) evaluate the outcomes of a pharmacist intervention on patient selection
of nonprescription and self-care products; and (2) evaluate patient confidence
with future self-treatment and satisfaction with the assistance of the pharmacist.
Methods: A prospective study will
be conducted in 2 national supermarket
chain pharmacies located in the Charlottesville, Virginia, area; 150 adult patients
aged ≥18 years will be eligible to participate in the study. The study will occur
over 4 months. Patients will be identified as needing assistance in choosing a
nonprescription or self-care product and
will self-select into the study by agreeing
to participate in the study intervention.
The study intervention is the pharmacist
consultation with the patient to assess
the self-care complaint and to make an
appropriate recommendation for care.
The pharmacist conducting the intervention will use a standardized method
of approaching self-care recommendations (i.e., SCHOLAR-MAC: symptoms,
characteristics, history, onset, location,
aggravating factors, remitting factors
and other medications, allergies, and
conditions). Each intervention will be
document the patient’s sex, age, and
chief complaint; medication patient initially selected; pharmacist recommendation after intervention; and outcome of
intervention and associated reasoning.
Patients will be asked about their confidence in future self-treatment, their
satisfaction with the intervention, and
whether they are more willing to ask
the pharmacist for future self-care assistance. The duration of the encounter also
will be recorded.
208—PREVALENCE OF PATIENT
SELF-CARE ERRORS ASSOCIATED
WITH OVER-THE-COUNTER CALCIUM SUPPLEMENTS. Gandhi J,
Malone C, Jewel-Osco, Winkler S, Midwestern University Chicago College of
Pharmacy, Wagner M, Jewel-Osco, Email: [email protected]
MA R /APR 2014 | 54:2 |
JAPhA e151
APhA2014 ABSTRACTS
Objective: The goal of this study is
to determine the prevalence of patient errors associated with the use of over-thecounter (OTC) calcium supplements.
Methods: A multicenter, prospective, survey-based study will be performed. Eligible participants will include
female participants ≥19 years of age
receiving a prescription oral bisphosphonate from 1 of 3 community grocery
store pharmacies in Naperville, Illinois.
Participants will be asked to complete a
multiple-choice survey regarding their
calcium supplement use to determine
the presence of dosing and administration drug therapy problems. Additional
items will identify demographic factors
that may impact self-care errors in certain populations. Surveys will be administered for a period of 20 weeks during
participant interaction at the pharmacy
pick-up window. Eligible participants
will complete the survey before leaving
the pharmacy. If the individual is not
present, the representative will be asked
to have the participant complete the survey at home and return it to the pharmacy within 1 week using a self-addressed
stamped envelope. Data will be collected
and analyzed with SPSS computer software.
estimated 43% of Americans use calcium
supplements. Evidence has shown the
prevalence of adverse events associated
with use of calcium supplements, but
few data have reported the prevalence of
supplement dosing and administration
errors. It is anticipated that data gathered
from this research will identify the need
for pharmacists to proactively counsel
patients on choice and use of OTC calcium supplements in order to reduce selfcare errors. Furthermore, pharmacist
intervention can lead to appropriate use
by patients, ultimately reducing adverse
events, the risk of complications and disease progression, and health care costs.
Pain Management
209—DEMOGRAPHICS
AND
CLINICAL CHARACTERISTICS OF
PATIENTS HOSPITALIZED WITH
PRESCRIPTION OPIOID-RELATED
OVERDOSE. Liu C, Jennings B, Uni-
e152 JAPhA | 5 4:2 | M AR/AP R 2014
versity of Utah Hospitals and Clinics,
Stevens V, University of Utah, Murnin
K, University of Utah Health Center, Email: [email protected]
Objective: Prescription medication
abuse and overdose is a rising national
problem. Among prescription drugs,
prescription opioid analgesics account
for more deaths than heroin and cocaine
combined. Ranked fourth nationally for
opioid-related deaths, Utah had an incidence rate 56% higher than the national
rate. The objective of this descriptive
study is to determine the demographics
and clinical characteristics of patients
who present for emergency department
(ED) visit or hospitalization for opioid
overdoses. This study may help identify
characteristics associated with patients
with opioid overdose and identify targets for future research.
Methods: This is a retrospective,
case-series study examining the demographics and clinical characteristics of
patients who were prescribed opioids
by a University of Utah outpatient clinic
provider and were hospitalized for opioid overdose. The study will identify patients with ED visits or hospitalizations
for opioid overdose in the past 5 years
using International Classification of Diseases–9th revision diagnosis and E codes
related to opioid and substance abuses.
Patients who had at least 1 prescription
for opioids written by a University of
Utah outpatient clinic provider will be
selected for study inclusion. Various patient characteristics and clinical history
will be collected using a standard data
collection sheet to ensure consistency
and completeness.
Q 210—DOSE PROPORTIONALITY
AND LINEARITY OF ACETAMINOPHEN AFTER SINGLE OR MULTIPLE ORAL DOSES OF MNK-795
OXYCODONE/ACETAMINOPHEN
EXTENDED-RELEASE
TABLETS.
Morton T, Brunelle R, Devarakonda K,
Mallinckrodt Inc., E-mail: [email protected]
Objective: The purpose of this analysis was to evaluate the dose proportionality and linearity of the acetaminophen
(APAP) component of oxycodone/
ja p h a .org
acetaminophen extended-release (OC/
APAP ER) when administered as 1, 2,
or 4 tablets (325 mg, 650 mg, or 1300 mg
APAP).
Methods: Data were pooled from
randomized, single- and multiple-dose
crossover studies conducted in healthy
adults. Single oral doses of OC/APAP
ER (7.5 mg OC/325 mg APAP) were administered as 1, 2, or 4 tablets (325 mg,
650 mg, or 1300 mg APAP) in 3 separate
studies. Multiple doses of 1 or 2 tablets of
OC/APAP ER (325 mg or 650 mg APAP)
were administered every 12 hours for 4.5
days (9 doses) in 2 separate studies. Individual plasma concentration versus actual time data were used to estimate the
pharmacokinetic parameters of APAP
by standard non-compartmental methods. Dose normalization (calculated as
plasma concentration divided by dose)
was utilized to compare concentrations
across different dosage strengths. Dose
linearity and proportionality were determined using linear regression of nontransformed data, including 95% confidence intervals. Safety and tolerability
were monitored.
Results: Data from 119 adults were
included in the single-dose studies and
57 adults in the multiple-dose studies.
After a single dose of OC/APAP ER,
both maximum concentration (Cmax) and
area under the plasma concentration–
time curve(AUC0-∞) for APAP were linear and dose proportional with respect
to dose, with dose-normalized slopes
approximately equal to zero (–0.001 and
–0.007, respectively). In the multipledose study, Cmax and AUC0-∞ of APAP
at steady state were also linear and proportional with respect to dose (slopes
of –0.004 and –0.011, respectively). The
most frequently reported treatmentemergent adverse events included nausea, vomiting, pruritus, dizziness, somnolence, and headache.
Conclusion: This pooled pharmacokinetic analysis demonstrates dose
proportionality and dose linearity of the
APAP component of OC/APAP ER up
to 1300 mg.
Original Citation: Morton T,
Brunelle R, Devarakonda K. Dose proportionality and linearity of acetaminophen after single or multiple oral doses
APhA2014 ABSTRACTS
of MNK-795 controlled-release oxycodone/acetaminophen (CR OC/APAP)
tablets. Presented at: PAINWeek 2013;
September 4-7, 2013; Las Vegas, NV.
Q 211—DOSE PROPORTIONALITY AND LINEARITY OF OXYCODONE AFTER SINGLE OR MULTIPLE ORAL DOSES OF MNK-795
EXTENDED-RELEASE
TABLETS.
Morton T, Brunelle R, Devarakonda K,
Mallinckrodt Inc., E-mail: [email protected]
Objective: The purpose of this analysis was to evaluate the dose proportionality and linearity of the oxycodone component of oxycodone/acetaminophen
extended-release (OC/APAP ER) tablets
when administered as 1, 2, or 4 tablets
(7.5 mg, 15 mg, or 30 mg oxycodone).
Methods: Data were pooled from
randomized, single- and multiple-dose
crossover studies conducted in healthy
adults. Single oral doses of OC/APAP
ER (7.5 mg OC/325 mg APAP) were administered as 1, 2, or 4 tablets (7.5 mg, 15
mg, or 30 mg oxycodone) in 3 separate
studies. Multiple doses of 1 or 2 tablets
of OC/APAP ER (7.5 mg or 15 mg oxycodone) were administered every 12
hours for 4.5 days (9 doses) in 2 separate
studies. Individual plasma concentration
versus actual time data were used to estimate the pharmacokinetic parameters
of oxycodone by standard non-compartmental methods. Dose normalization
(calculated as plasma concentration divided by dose) was utilized to compare
concentrations across different dosage
strengths. Dose linearity and proportionality were determined using linear
regression of non-transformed data, including 95% confidence intervals. Safety
and tolerability were monitored.
Results: Data from 119 adults were
included in the single-dose studies and
57 adults in the multiple-dose studies.
After a single dose of OC/APAP ER,
both maximum concentration (Cmax) and
area under the plasma concentration–
time curve (AUC0-∞) for oxycodone were
linear and proportional with respect to
dose, with dose-normalized slopes approximately equal to zero (–0.001 and
–0.024, respectively). In the multiple-
dose study, Cmax and AUC0-∞ of oxycodone at steady state were also linear and
proportional with respect to dose (slopes
were –0.003 and 0.033, respectively). The
most frequently reported treatmentemergent adverse events included nausea, vomiting, pruritus, dizziness, somnolence, and headache.
Conclusion: This pooled pharmacokinetic analysis demonstrates dose
proportionality and dose linearity of the
oxycodone component of OC/APAP ER
up to 30 mg.
Original Citation: Morton T,
Brunelle R, Devarakonda K. Dose proportionality and linearity of oxycodone
after single or multiple oral doses of
MNK-795 controlled-release oxycodone/acetaminophen (CR OC/APAP)
212—EVALUATION OF A COMPOUNDED PAIN MANAGEMENT
MEDICATION SERVICE IN AN INDEPENDENT COMMUNITY PHARMACY. Houmes S, Layson-Wolf C, University of Maryland School of Pharmacy,
Klempay J, Zaremba S, Van Wie W,
Professional Pharmacy, E-mail: cwolf@
rx.umaryland.edu
Objective: The objectives of this survey are to: (1) evaluate patient satisfaction with pain management compounded prescriptions; and (2) evaluate patient
satisfaction with the follow-up service
related to the prescription.
Methods: Participants are included
if they are ≥18 years of age and received
a compound at the pharmacy or via mail.
Patients receive a call at 1 week for initial
counseling and a call at week 3 to assess efficacy. A voluntary, anonymous,
14-item survey, cover letter, and raffle
slip are mailed to patients at week 3. The
survey lists statements about satisfaction with compounds and the follow-up
service. Patients respond using a Likert
scale (1 = strongly disagree; 5 = strongly
agree). Participants are asked to circle the
group of symptoms that best describes
their pain. A comment box will be included for participants to write in comments. Participants will be entered into a
raffle for gift cards. A reminder postcard
is mailed at week 5. The surveys will be
j apha.org
mailed from and returned to the university to further prevent bias.
collection will begin October 1, 2013 and
continue until February 1, 2014; surveys
returned after the end date will not be included for analysis. Statement response,
inferred pain management compound
(based on symptom group), and total
responses will be reported using descriptive statistics. The estimated sample size
is 300 based on dispensing trends. The
data from this survey will be used to
evaluate whether changes are needed
to improve patient satisfaction with
the compounds and follow-up service.
Other pharmacies implementing a compound follow-up service could utilize
the data to assist with service design.
213—EVALUATION OF OPIATE
REDUCTION PROTOCOL IN PAIN
MANAGEMENT PATIENTS AT A
Kafader S, Fred Meyer Pharmacy,
Ramirez S, Oregon State University,
Davis J, Fred Meyer Pharmacy, E-mail:
[email protected]
Objective: The objective of this project was to evaluate the effectiveness of
an opiate reduction protocol, involving a
controlled substance committee, in pain
management patients at a community
health center. Patients with chronic pain
were referred to the controlled substance
committee which provided a recommendation to the provider for reducing
opiate pain medication use. The protocol
was designed to achieve a safe level of
opiate pain medications in patients with
chronic pain and to reduce the risk of adverse drug events in these patients.
Methods: The project was a retrospective, case-control chart review
involving patients from a community
health center. A group of 100 chronic
pain patients were selected from a
6-month period before the creation of
the opiate reduction protocol to serve as
a control group, while the experimental group was composed of 100 chronic
pain patients selected from a 6-month
period after the creation of the protocol.
Patients were eligible for inclusion if they
were: >18 years of age; being treated for
chronic, non-cancer pain at the commuMA R /APR 2014 | 54:2 |
JAPhA e153
APhA2014 ABSTRACTS
nity health center; and receiving opiate
pain medications at a level of ≥120 mg
morphine dose equivalents. Data were
collected from chart review that included
level of opiate pain medication on day 1
of study period and 6 months later, percent reduction from baseline of opiate
pain medication, and evidence that protocol was followed by practitioners. Data
analysis included the percentage of patients reaching the primary endpoint of
<120 mg morphine dose equivalents as
well as secondary endpoints of percent
reduction from baseline of opiate medication, and percent of providers who
followed recommendations. Data were
analyzed using descriptive statistics and
the control and experimental groups
were compared using a t test and a chisquare test.
Q 214—HALF-VALUE DURATION
ANALYSIS FOR ACETAMINOPHEN
AFTER SINGLE AND MULTIPLE
DOSES OF ORAL MNK-795 OXYCODONE/ACETAMINOPHEN EXTENDED-RELEASE TABLETS. Ping
H, Brunelle R, Morton T, Devarakonda
K, Mallinckrodt Inc., E-mail: [email protected]
Objective: This analysis examines
the half-value duration (HVD) of the
APAP component of oxycodone/acetaminophen extended-release (OC/
APAP ER) after single and multiple
doses compared with the HVD of immediate-release (IR) OC/APAP. HVD is
defined as the time during a dosing cycle
when plasma concentrations are at least
half of the maximum concentration (50%
Cmax) and can help describe the pharmacokinetic (PK) performance of extendedrelease products.
Methods: HVD and conventional
PK measures (Cmax, Tmax, area under the
plasma concentration time curve [AUC])
for APAP from OC/APAP ER (2 tablets [15 mg/650 mg] administered once
[single dose] or q12h over 4.5 days [multiple dose]) were compared with values
from IR OC/APAP (7.5 mg/325 mg; 1
tablet twice, 6 hours apart [single dose,
15 mg/650 mg total] or q6h for 4.5 days
[multiple dose]) using data from 2 randomized, open-label, crossover studies
e154 JAPhA | 5 4:2 | M AR/AP R 2014
(single dose [n = 29], multiple dose [n =
24]) in healthy adults. Blood samples for
bioanalysis were collected up to 36 hours
(single-dose study) or up to 132 hours
(multiple-dose study). Safety and tolerability were monitored.
Results: Conventional PK measures
(Cmax, Tmax, and AUC) for APAP were
similar for OC/APAP ER and IR OC/
APAP in both studies. The mean HVD
of APAP was not significantly different
for OC/APAP ER versus IR OC/APAP
after single doses. During steady state,
however, the mean HVD of APAP with
OC/APAP ER was significantly longer
versus IR OC/APAP (4.24 h vs. 3.11 h;
P = 0.024). OC/APAP ER was generally
well tolerated.
Conclusion: In this analysis, the Cmax,
Tmax, and AUC of APAP following single
and multiple doses of OC/APAP ER (2
tablets, 15 mg/650 mg) were consistent
with IR OC/APAP (1 tablet, 7.5 mg/325
mg) taken q6h; however, the HVD for
APAP of OC/APAP ER was significantly longer than the HVD for IR OC/APAP
with steady-state dosing.
Original Citation: Ping H, Brunelle
R, Morton T, Devarakonda K. Half-value
duration analysis for acetaminophen
after single and multiple doses of oral
MNK-795 controlled-release oxycodone/acetaminophen (CR OC/APAP)
Q 215—HALF-VALUE DURATION
ANALYSIS
FOR
OXYCODONE
AFTER SINGLE AND MULTIPLE
DOSES OF ORAL MNK-795 OXYCODONE/ACETAMINOPHEN EXTENDED-RELEASE TABLETS. Ping
H, Brunelle R, Morton T, Devarakonda
K, Mallinckrodt Inc., E-mail: [email protected]
Objective: This analysis examines
the half-value duration (HVD) of oxycodone from oxycodone/acetaminophen
extended-release (OC/APAP ER) after
single and multiple doses compared
with immediate-release (IR) OC/APAP.
HVD is a complementary measure of
the pharmacokinetic (PK) performance
of extended-release products, and is defined as the time during a dosing cycle
when plasma concentrations are at least
ja p h a .org
half of the maximum concentration (50%
Cmax).
Methods: HVD and conventional PK
measures (Cmax, Tmax, and area under the
plasma concentration time curve [AUC])
for oxycodone from OC/APAP ER (2
tablets [15 mg/650 mg] administered
once [single dose] or q12h over 4.5 days
[multiple dose]) were compared with
values from IR OC/APAP (7.5 mg/325
mg; 1 tablet twice, 6 hours apart [single
dose, 15 mg/650 mg total] or q6h for 4.5
days [multiple dose]) using data from 2
randomized, open-label, crossover studies in healthy adults (single dose [n = 29],
multiple dose [n = 24]). Blood samples
for bioanalysis were collected up to 36
hours (single-dose study) or up to 132
hours (multiple-dose study). Safety and
tolerability were monitored.
Results: In both single- and multiple-dose studies, the mean Cmax of oxycodone was lower for OC/APAP ER compared with IR OC/APAP, whereas AUC
measurements were similar. The mean
HVD of oxycodone was significantly
longer for OC/APAP ER compared with
IR OC/APAP after initial administration
(single dose, 9.65 h vs. 5.94 h; P<0.0001)
and at steady state (multiple dose, 7.85 h
vs. 5.79 h; P<0.001). OC/APAP ER was
generally well tolerated.
Conclusion: HVD indicates a longer
time above 50% of the Cmax for oxycodone plasma concentrations with OC/
APAP ER administered every 12 hours
compared with IR OC/APAP administered every 6 hours. These findings support administration of OC/APAP ER
every 12 hours to manage moderate to
severe acute pain.
Original Citation: Ping H, Brunelle
R, Morton T, Devarakonda K. Half-value
duration analysis for oxycodone after
single and multiple doses of oral MNK795 controlled-release oxycodone/acetaminophen (CR OC/APAP) tablets. Presented at: PAINWeek 2013; September
4-7, 2013; Las Vegas, NV.
216—WITHDRAWN.
Q 217— A NOVEL FORMULATION
OF IBUPROFEN SODIUM HAS A
FASTER ONSET OF ANALGESIA
THAN STANDARD IBUPROFEN
APhA2014 ABSTRACTS
TABLETS IN THE TREATMENT OF
POSTOPERATIVE DENTAL PAIN.
Brain P, Jean Brown Research, Leyva R,
Pfizer Consumer Healthcare, Doyle G,
Independent Consultant, Kellstein D,
Pfizer Consumer Healthcare, E-mail: [email protected]
Objective: This study was conducted to test the clinical relevance of faster
ibuprofen (IBU) absorption observed
with Advil film-coated tablets (IBUNa),
a newly available IBU sodium formulation, compared with standard IBU tablets to onset of analgesia and overall analgesic efficacy.
Methods: This randomized, doubleblind, single-center, 8-hour inpatient
study employed the third molar extraction model of dental pain in 316 subjects with at least moderate postsurgical
baseline pain. Subjects were randomized
2:2:2:1 to receive a single dose of IBUNa
(2x256 mg; equivalent to 400 mg IBU; n
= 95), Advil (IBUAdv; 2x200 mg; n = 86),
Motrin (IBUMot; 2x200 mg; n = 87), or placebo tablets (n = 48). Primary endpoints
were time-weighted sum of pain relief
and pain intensity differences over 8
hours (SPRID 0–8) and time to meaningful pain relief (TMPR), assessed using the
double-stopwatch method.
Results: Mean SPRID 0–8 scores
were significantly greater for IBUNa
and the other active treatments versus
placebo (P<0.001). The IBUNa group
reported TMPR significantly earlier
(median 42.4 minutes) than placebo (>8
hours), pooled IBUAdv/IBUMot (median
55.3 minutes), and IBUMot (median 60.7
minutes) (all P<0.001) and marginally
faster than IBUAdv (median 52.0 minutes;
P = 0.075). By study end, 95.8%, 88.4%,
94.2%, 82.8%, and 22.9% of subjects in
the IBUNa, pooled IBUAdv/IBUMot, IBUAdv,
IBUMot, and placebo groups, respectively,
achieved meaningful pain relief. Secondary endpoint comparisons of IBUNa
versus placebo, including time to first
perceptible pain relief; SPRID 0–2,–3,
and –6 scores; time to treatment failure;
and global evaluation of treatment, were
consistent with the primary findings.
Nausea and vomiting were the most
common adverse events; all were mildly
or moderately severe and similar across
treatment groups. No serious adverse
events or discontinuations due to adverse events occurred.
Conclusion: IBUNa provides more
rapid onset of analgesia than standard
IBU tablets and placebo and represents a
new treatment option for rapid relief of
acute pain.
Funded by Pfizer Consumer Healthcare.
Original Citation: 32nd Annual Scientific Meeting of the American Pain Society, May 8–11, 2013, New Orleans, LA;
PAINWeek 2013, September 4–7, 2013,
Las Vegas, NV; 2013 Annual Meeting of
the American College of Clinical Pharmacy, October 13–16, 2013, Albuquerque, NM
Q 218—A NOVEL FORMULATION
OF IBUPROFEN SODIUM IS ABSORBED FASTER THAN STANDARD IBUPROFEN TABLETS. Legg
T, CoxHealth, Leyva R, Kellstein D, Pfizer Consumer Healthcare, E-mail: david.
[email protected]
Objective: These studies were conducted to determine the pharmacokinetic profile of Advil film-coated tablets
(IBUNa) containing ibuprofen sodium, a
newly available formulation developed
for fast absorption.
Methods: Two randomized, openlabel, 5-way crossover, pharmacokinetic
studies were conducted to evaluate the
rate (maximum concentration) and extent (area under the concentration-time
curve to last measurement) of IBU absorption after single doses of IBUNa tablets compared with other marketed IBU
formulations.
Results: The 2 studies were completed by 71 healthy adults (N=36 and
N=35, respectively). IBUNa (2x256 mg;
equivalent to 400 mg IBU free acid) was
bioequivalent to other fast-absorbed IBU
formulations—Advil Liqui-Gels (IBULG;
2x200 mg) in the fasted and fed states and
Advil FastGel (IBUFG; 2x200 mg) and Nurofen Express (IBU lysine [IBULys]; 2x342
mg; equivalent to 400 mg IBU free acid)
in the fasted state—for rate and extent of
IBU absorption. In the fasted state, IBUNa
was bioequivalent to Motrin IB (IBUMot),
Advil (IBUAdv), and Nurofen (IBUNur)
(each 2x200 mg) tablets for extent of absorption, but was absorbed significantly
j apha.org
faster than all 3 standard ibuprofen tablet
formulations. The median IBUNa time to
maximum concentration (Tmax) was 30 to
35 minutes, comparable to IBULG, IBUFG,
and IBULys (median Tmax = 40, 40, and 35
minutes, respectively), but much faster
than IBUMot, IBUNur, and IBUAdv (median
Tmax = 120, 120, and 82 minutes, respectively). In the fed state, IBUNa and IBULG
had the same median Tmax (90 minutes).
Adverse events (AEs) were balanced
across treatments and mostly mild in
severity; the most common AEs were
headache and dizziness.
Conclusion: These data demonstrate that IBUNa is absorbed at a faster
rate than, but to a similar extent as, standard ibuprofen tablets. Moreover, IBUNa
reaches peak concentrations in 30 to 35
minutes, comparable to other fast-absorbed ibuprofen formulations and >45
minutes faster than standard formulations.
Original Citation: 32nd Annual Scientific Meeting of the American Pain Society, May 8–11, 2013, New Orleans, LA;
PAINWeek 2013, September 4–7, 2013,
Las Vegas, NV; 2013 Annual Meeting of
the American College of Clinical Pharmacy, October 13–16, 2013, Albuquerque, NM
Q 219—OPEN-LABEL SAFETY OF
MNK-795,
EXTENDED-RELEASE TABLETS, IN PATIENTS
WITH
OSTEOARTHRITIS
OR
CHRONIC LOW BACK PAIN. Nalamachu S, International Clinical Research Institute Inc., Barrett T, Kostenbader K, Young J, Mallinckrodt Inc., Email: [email protected]
this study was to demonstrate the safety
and tolerability of oxycodone/acetaminophen extended-release tablets (OC/
APAP ER) with up to 35 days of use.
Methods: This multicenter, phase
3, open-label study included adult patients who had been diagnosed with
osteoarthritis (OA) of the knee or hip
with moderate to severe pain despite the
use of nonopioid or opioid analgesics,
or moderate to severe chronic low back
MA R /APR 2014 | 54:2 |
JAPhA e155
APhA2014 ABSTRACTS
pain (CLBP) present for several hours
per day for at least 3 months. Study medication was OC/APAP ER (2 tablets [15
mg OC/650 mg APAP] q12h) for up to
35 days. The primary endpoint was measured by time to discontinuation, change
from baseline physical examination findings, vital signs, pulse oximetry, clinical
laboratory tests, liver function test results, and treatment-emergent adverse
events. Descriptive statistics included
mean, standard deviation, median, minimum, and maximum, and all categorical/qualitative data are presented using
frequency counts and percentages.
Results: Of 376 patients enrolled (n
= 141 OA, n = 235 CLBP), 75.8% completed the study (69.5% OA, 79.6%
CLBP). Treatment-emergent adverse
events that occurred in >5% of patients
were nausea (23.1%), vomiting (15.2%),
dizziness (14.9%), somnolence (11.4%),
constipation (11.2%), pruritus (7.2%),
and headache (5.1%). Liver function
tests shifted from normal at baseline to
elevated at study end in 0.3% to 6.9% of
patients, depending on the measure. Ten
patients had liver function test results
deemed clinically significant; this resulted in study discontinuation for 5 patients
(with subsequent resolution). Changes
in physical examination findings, vital
signs, and oxygen saturation were not
clinically significant, with the exception
of 1 patient who experienced treatmentrelated hypopnea and discontinued the
study. Substantial decreases in pain intensity were observed for both patient
groups.
Conclusion: In this study, OC/
APAP ER was generally well tolerated
for up to 35 days in patients with OA and
CLBP who had moderate to severe pain.
Original Citation: Nalamachu SR,
Barrett T, Ward J, Giuliani M, Kostenbader K, Young J. Open-label safety of
MNK-795, controlled-release oxycodone/acetaminophen tablets (CR OC/
APAP), in patients with osteoarthritis
or chronic low back pain. Presented at:
PAINWeek 2013; September 4-7, 2013;
Las Vegas, NV.
220—STUDENT
SATISFACTION
WITH PAIN MANAGEMENT IN
PHARMACY SCHOOL: A SURVEY
e156 JAPhA | 5 4:2 | M AR/AP R 2014
OF THREE PHARMACY CLASSES
AT A NEW SCHOOL OF PHARMACY
SCHOOL. Troccia A, Wegmans School
of Pharmacy at St. John Fisher College, Email: [email protected]
was to elicit student pharmacists’ perceptions and knowledge of pain management. The Institute of Medicine has
noted that pain management is inadequate in the United States and many
patients will seek self-care first. Pharmacists and pharmacy schools are well positioned to address this important public
health problem, but little is known about
satisfaction with training.
Methods: In April 2013, students (N
= 255) in 3 pharmacy school graduate
classes (P1, P2, and P3) were surveyed
with questions that assessed both their
personal perception and clinical opinion on pain management as an entity.
The topic of questions covered were addressed with the following subsets: etiology of pain, knowledge of pain medications, assessment of pain management
implementation into doctor of pharmacy
programs, motivation to manage pain
in a clinical setting, assessment for the
difference between diversion and a true
need for management, and the impact of
expanded pain management techniques.
Results: P3 students were more
confident in their knowledge of pain
etiology and management than others.
Perception of pain being a manageable
and true issue had gone from a state of
uncertainty or strongly disagreeing to a
more agreeing and accepting nature. Responses to the question “I feel that managing a patient’s pain in the pharmacy is
a pharmacist’s responsibility” were as
follows: P1 (n = 72) disagree 23%; P2 (n
= 70) disagree 13%; P3 (n = 60) disagree
7%. As students were early on in their didactic studies, their baseline knowledge
of pain and its management was significantly lower than those students who
had progressed further in the program.
Conclusion: Professional pharmacy
students were shown to have a gradually
increased knowledge of pain management and recognition of pain as an issue
that is more than just a patient complaint
to obtain unnecessary medications and
attempt diversion.
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221—TOPICAL KETAMINE IN THE
TREATMENT OF COMPLEX REGIONAL PAIN SYNDROME. Mekhjian H, Goad J, Durham M, University of
Southern California, E-mail: mekhjian@
usc.edu
study are to: (1) assess changes in numeric pain intensity scores after using topical ketamine in the treatment of complex
regional pain syndrome (CRPS); and (2)
assess adverse effects associated with
topical ketamine.
Methods: Ketamine is a general
anesthetic and a noncompetitive Nmethyl-D-aspartate (NMDA) receptor
antagonist with opioid activity. Ketamine hydrochloride is approved for
intravenous and intramuscular use and
is available in a bulk powder. Parental
and oral forms of ketamine have shown
some promise for treating the burning
pain and exquisite skin hypersensitivity, allodynia, of CRPS and other chronic
pain states associated with nerve injury.
Several randomized, double-blind, placebo-controlled studies have reported
on the reduction of allodynia following intravenous administration of ketamine, but central nervous system (CNS)
adverse effects may limit use. Topical
formulations of ketamine can be compounded to reduce CNS adverse effects
and increase patient acceptance. There
are limited data on the use of topical ketamine to treat CRPS. This is a retrospective chart review of pain center patients
who have used topical ketamine during
the study period of April 2010 to April
2013. Patients will be followed up to the
point of discontinuation of therapy or
the end of the study period. Inclusion criteria consist of patients seen at this pain
center and have received compounded
topical ketamine according to pharmacy
records. Patients will be excluded if they
have been prescribed topical ketamine
for pain syndromes other than CRPS, if
they have started other pain medications
concurrently with topical ketamine, if
they picked up a prescription for topical ketamine but never used it, or if they
are <18 years of age. Data collected will
include dose and duration of topical ketamine use, pain scores, adverse effects,
comorbid conditions, and basic demo-
APhA2014 ABSTRACTS
graphics. Data will be analyzed using
descriptive statistics.
Q 222—TREATMENT OF EPISODIC TENSION-TYPE HEADACHE
WITH A NOVEL FORMULATION
OF IBUPROFEN SODIUM. Packman
E, Institute for Applied Pharmaceutical
Research, Leyva R, Kellstein D, Pfizer
Consumer Healthcare, E-mail: david.
[email protected]
Objective: This study was conducted to test the clinical relevance of faster
ibuprofen (IBU) absorption observed
with Advil film-coated tablets (IBUNa),
a newly available ibuprofen sodium
formulation, compared with standard
IBU tablets in the treatment of episodic
tension-type headache (ETTH).
Methods: This randomized, double-blind, single-center, parallel-group
study included subjects aged 18 to 65
years with a history of ≥4 ETTH attacks
per month for the past 6 months. Subjects reporting at least moderately severe
baseline headache pain were randomized 2:2:1 to single-dose IBUNa (2x256
mg; equivalent to 400 mg standard IBU),
Motrin (IBUMot; 2x200 mg), or placebo.
Primary endpoints were time-weighted
sum of pain relief rating (PRR) and pain
intensity difference (PID) scores over
3 hours (SPRID 0–3) and time to meaningful pain relief (TMPR), assessed using the double-stopwatch method. Secondary endpoints included time to first
perceptible pain relief (TFPR) confirmed
by TMPR; sum of PRR and PID scores
(PRID) at 1, 2, and 3 hours postdose; and
time-weighted sum of PRR, PID, and
PRID scores over 2 and 3 hours.
Results: Eligible subjects (N = 226)
were randomized to IBUNa (n = 91), IBU(n = 89), and placebo (n = 46). IBUNa
Mot
and IBUMot had significantly better mean
SPRID 0–3 scores than placebo (P<0.001),
but were not significantly different from
each other. Summed secondary endpoints revealed similar results. Median
TMPR was significantly faster in both active treatment groups (IBUNa = 40.6 min;
IBUMot = 48.5 min) versus placebo (>180
min; P<0.001). The prespecified TMPR
analysis showed no difference between
IBUNa and IBUMot (P = 0.253); however,
a post-hoc analysis assigning higher
weight to earlier time points indicated
that IBUNa provided faster TMPR and
TFPR than IBUMot (P = 0.022 and 0.018,
respectively). No adverse events were
reported.
Conclusion: IBUNa is effective and
safe in the treatment of ETTH. A posthoc analysis indicates that IBUNa provides an appreciably faster onset of analgesia than standard IBU tablets.
Original Citation: 55th Annual
Meeting of the American Headache Society (AHS), held in conjunction with the
16th Biennial Congress of the International Headache Society (IHS), June 27–
30, 2013, Boston, MA; PAINWeek 2013,
September 4–7, 2013, Las Vegas, NV;
2013; Annual Meeting of the American
College of Clinical Pharmacy, October
13–16, 2013, Albuquerque, NM
Patient Attitudes and Behavior
223—ARE CHILDREN WITH ASTHMA OVERCONFIDENT THAT THEY
ARE USING THEIR INHALERS
CORRECTLY?. Carpenter D, Geryk
L, University of North Carolina at Chapel Hill Eshelman School of Pharmacy,
Weaver M, University of North Carolina
at Chapel Hill, DeWalt D, University of
North Carolina at Chapel Hill School of
Medicine, Sleath B, University of North
of Pharmacy, E-mail: dmcarpenter@unc.
edu
Objective: Prior research has shown
that most children with asthma have
suboptimal inhaler technique. A potential reason children may have poor technique is because they are unaware that
they are using their inhaler incorrectly.
The objective of this study is to document the extent to which children with
asthma are overconfident that they are
using their inhalers correctly.
Methods: Children (n = 91) aged 7
to 17 years with persistent asthma were
recruited at 2 nonurban pediatric practices in North Carolina. Eligible children
demonstrated their inhaler technique
for metered-dose inhalers either with
or without a spacer at an office visit and
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again 1 month later. Children were dichotomized into 2 groups based on their
level of inhaler self-efficacy: either “completely sure” or “not completely sure”
they were using their inhaler correctly.
The mean number of inhaler steps (out of
8) children performed incorrectly for the
2 groups was examined. A linear mixed
model was run for children in the “completely sure” group to determine whether demographic factors predicted their
overconfidence, defined as the number
of inhaler steps they missed.
Results: Children were primarily
male (56%) and non-white (60%). Sixtyeight (75%) children were completely
sure they used their inhalers correctly
at the office visit. Children in the “completely sure” group missed an average
of 1.5 steps whereas children in the “not
completely sure” group missed an average of 1.8 steps. There was no evidence
found that demographic characteristics
were associated with the number of steps
that the “completely sure” group missed.
Conclusion: In this study, children
who were completely sure that they used
their inhalers correctly still missed an
average of 1.5 steps. Simply asking children about correct inhaler use is unlikely
to identify children who do not use their
inhalers correctly. Pharmacists should
ask children to demonstrate inhaler technique so they can instruct children in
proper technique.
224—ASSESSMENT OF PATIENT
PERCEPTIONS
REGARDING
PHARMACISTS AS PROVIDERS
IN COLLABORATIVE MODELS OF
CARE. Grimshaw S, Cost M, Black B,
Tennessee Pharmacists Association, Email: [email protected]
Objective: As Tennessee and other
states implement and update laws, regulations, and practice acts to reflect current collaborative models of care involving pharmacists, all stakeholder groups,
including prescribers, pharmacists, other
providers, patients, and the general public, should be knowledgeable regarding
the purpose for these models of care
and the growing need for pharmacists
in our health care system. Although recent research has demonstrated positive
prescriber and pharmacist perceptions
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JAPhA e157
APhA2014 ABSTRACTS
regarding the inclusion of pharmacists
in collaborative models of care, very few
studies exist that assess patients’ perceptions. Thus, this research study seeks to
assess patients’ perceptions of pharmacists as providers and pharmacists’ roles
in collaborative models of care. This
study further seeks to analyze and evaluate participants’ responses to assist in the
future development and implementation of collaborative models of care.
Methods: This research study will
utilize a prospective, web-based survey
to assess patient perceptions. The survey
will be disseminated to patients through
the Tennessee Pharmacists Association
(TPA) membership using multiple methods of delivery, including electronic
devices and web-based methods. The
survey link will be open for 60 days, after
which time the survey data will be analyzed. Patient participation will be voluntary, and responses will be collected
anonymously. Patients will be asked to
provide demographic information and
will be eligible to complete the survey
if they are ≥18 years old, either live or
work in Tennessee, and have sought or
received information or services from
a pharmacist or student pharmacist. Instructions for accessing the online survey
will be distributed to patients through
communications with TPA members,
which includes pharmacists and student
pharmacists in multiple direct patient
care settings, such as community and
health-system pharmacy practices, colleges of pharmacy, student pharmacist–
organized patient care events, and other
public outreach and awareness events.
225—LIGHTS, CAMERA, ACTION:
EVALUATING THE PORTRAYAL
OF PHARMACISTS IN FILM AND
TELEVISION. Yanicak A, Monterroyo
P, Chappell A, Tavassoli S, Furgiuele G,
Waddington L, South Carolina College
of Pharmacy, Willliams J, University
of South Carolina, Bookstaver P, South
Carolina College of Pharmacy, E-mail:
[email protected]
Objective: Media portrayals of pharmacists may represent the public’s view
of the profession and may influence
viewer perception. The purpose of this
e158 JAPhA | 5 4:2 | M AR/AP R 2014
study was to characterize the portrayal
of pharmacists appearing in movies and
television shows since 1970 and assesses
trends over time.
study of all references to pharmacists in
movies and television available in the
United States from January 1970 to July
2013. A comprehensive search of the Internet Movie Database, including characters, summaries, and scripts was conducted. Internet searches using Bing and
Google search engines also were used
to identify additional data. Electronic
inquiries requesting input of known
pharmacist portrayals were distributed
to pharmacy professionals in national,
regional, and state pharmacy organizations. The study team viewed all identified references, primarily to evaluate
the portrayal of pharmacist characters
as positive, negative, or neutral as determined by an algorithm developed
by study investigators. A 20% random
sampling was viewed by a second investigator. Year and genre of media, demographic information of pharmacist,
and victim, hero, or villain status were
recorded if available. Data also were
analyzed for trends over decades and
compared with actual pharmacist demographics.
Results: Based on 274 nonduplicate
submissions, 205 unique portrayals of
pharmacists in film and television were
identified, viewed and evaluated after
removing exclusions. Pharmacists were
primarily portrayed as white (75%), male
(75%), younger than the age of 50 years
(57%), working in a community pharmacy setting. The majority of portrayals
were characterized as negative (62%)
while 21% were determined to be neutral. There were 2.9 times as many pharmacists portrayed as victims compared
with portrayals as heroes. Pharmacists
mostly played minor character roles
with single appearances.
Conclusion: These results highlight
a potential concern in the public’s view
and lack of knowledge of the changing
dynamics in the profession.
226—PATIENT PERCEPTIONS OF
PHARMACOGENOMIC TESTING
IN A COMMUNITY PHARMACY
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SETTING. Dorosti Y, Goad J, University
of Southern California School of Pharmacy, Sarino L, Ralphs Pharmacy, E-mail:
[email protected]
study are to: (1) assess patient knowledge, attitudes, beliefs, and practices
(KABP) regarding pharmacogenomics
after a genetic risk test; (2) compare attitudes and beliefs among people with no
risk versus any percent of risk on the genetic risk test; and (3) determine whether
there is a linear correlation between
KABP and the genetic risk assessment
score.
Methods: Community pharmacists
play a key role in reducing adverse drug
events and improving the efficacy of
treatment by identifying key interactions
in a patient’s medication profile. Personalized medicine uses pharmacogenomic
markers to determine optimal drug doses for certain medications and to predict
safety issues related to metabolism and
drug interactions. These biomarkers require a blood test and are approved by
the Food and Drug Administration and
included in certain drug labels. While the
benefits may seem to clear to clinicians,
literature indicates patients are unclear
about the risks and benefits of pharmacogenomics. This study is a prospective survey of patients presenting to the
community pharmacy for a proprietary
web-based genetic risk assessment test
from November 2013 to March 2014. An
anonymous paper-based KABP survey
will be administered in conjunction with
the web-based genetic risk test, which
calculates a genetic risk score using patient medication profiles and population statistics. The knowledge part of the
survey will be administered before the
genetic risk test and the remainder of the
questions administered following the
standard post-test result counseling. The
calculated genetic risk score, medication
list, age, and sex will be recorded on the
survey. To be included in the study, subjects must be ≥18 years of age and take ≥2
medications. Data will be analyzed using
descriptive and inferential statistics.
227—PATIENT
OF PRIMARY
PERCEPTIONS
NONADHERENCE
APhA2014 ABSTRACTS
BASED ON UNCLAIMED PRESCRIPTIONS AT A COMMUNITY
PHARMACY. Iskanian R, University of
Southern California, E-mail: riskanian@
westernu.edu
Objective: This study seeks to: (1)
determine patient-stated reasons for not
claiming new prescriptions; (2) evaluate
the types of prescriptions not claimed by
patients; and (3) determine if there is a
correlation with chronic medication refill
pattern and primary nonadherence.
Methods: Poor adherence to prescribed drug therapies is dangerous
to patients and costly to the health care
system. Primary nonadherence results
when a patient is prescribed a medication, but fails to start it. In the pharmacy,
unclaimed medications may account for
$150 billion annually in treatment failures and wasted resources. While studies
showing nonadherence to medications
and poor clinical outcomes have been
reported, those on patient perceptions on
claim status have not been reported. This
is a phone-based survey study of patients who fail to claim a prescribed medication within 14 days during November
2013 to April 2014. Patients will be excluded from the survey if they are <18
years of age, not receiving a new medication, or the patient or caregiver cannot
be reached. Other data collected from
pharmacy records will include name and
class of medication, insurance type, refill
pattern of other medications on profile,
and age. Data will be evaluated with descriptive and inferential statistics.
228—PATIENT PERSPECTIVE ON
THE UTILIZATION OF COMMUNITY PHARMACISTS AS TRAVEL
HEALTH CONSULTANTS. Tran A,
University of Illinois Chicago College
of Pharmacy, Sommers-Hanson J, Walgreens, Allen S, University of Illinois
Chicago College of Pharmacy, MalikIsmail I, Walgreens, E-mail: atran013@
gmail.com
is to assess patients’ needs and perceptions on travel health services provided
by community pharmacists in order to
gain insight for the implementation of
these services.
Methods: A cross-sectional study
will be conducted using a voluntary,
anonymous survey instrument and offered to participants who have traveled
internationally in the past or will be traveling within the next year. Participants
will be excluded if they are <18 years
of age or are unable to read and write
in English. The survey will ask a series
of questions that assesses participants’
needs for travel health care services and
their perceptions on how knowledgeable
and skilled community pharmacists are
in providing travel health consultation
regarding travel immunizations, medications, and supplies. The questions
also will provide insight on the participants’ likelihood of seeking those products and services through a community
pharmacy, as well as the willingness to
compensate a pharmacist for the travel
health consultation. Participants will
have the option of completing the survey
on paper at the pharmacy where offered
or electronically, both of which are preceded with an informed consent clause.
Survey responses will be transcribed by
the principal investigator into a secure,
password-protected spreadsheet that
can then be utilized for data analysis and
the study presentation. Statistical analyses will include calculations for overall
frequencies and measures of central tendency.
Results: Research in progress. Release of the surveys is scheduled for October 15. It is important to understand
not only the patients’ needs and expectations for travel health services, but
also to recognize their perceptions on the
capabilities of community pharmacists
in providing comprehensive pre-travel
health care. The information uncovered
by this research will help in establishing
a successful and effective travel health
program within a community pharmacy.
229—PATIENT
SATISFACTION
WITH A COMMUNITY-BASED
MEDICATION
SYNCHRONIZATION PROGRAM. Butler K, Price
Chopper, Ruisinger J, University of Kansas School of Pharmacy, Vink J, Price
Chopper, Melton B, University of Kansas
School of Pharmacy, E-mail: [email protected]
j apha.org
Objective: This study seeks to determine satisfaction with a community
pharmacy–based medication synchronization program. Improving medication
adherence plays a crucial role in optimizing patient care and increasing pharmacy revenue.
Methods: A pharmacy chain in the
Kansas City metropolitan area currently
offers a medication synchronization program to patients at 1 location. The program, Time My Meds (TMM), launched
July 2013, allows medications to be synchronized on a 30- or 90-day basis. Currently, approximately 70 patients are
enrolled. This study is a cross-sectional
survey, which will be administered to
patients after 3 months of program participation, to determine patient satisfaction with the program. The survey will
collect demographic information along
with satisfaction questions modified
from the diabetes disease state management questionnaire (DDSM-Q) using a 5-point Likert scale (1 = strongly
disagree; 5 = strongly agree). Program
participants include patients or caregivers ≥18 years of age, picking up at least 3
months of synchronized fills. Those with
refills only occurring every 90 days will
be excluded from the study. Study eligibility will be determined using refill history extracted from pharmacy and TMM
software. Printed surveys will be distributed to participants when they pick up
medications at the pharmacy. Participants will place completed surveys in a
sealed box. Descriptive statistics will be
used to evaluate patient demographics.
Program satisfaction will be evaluated
using chi-square with an a priori alpha
of 0.05.
Results: Research in progress. Results are expected to provide insight into
satisfaction with a medication synchronization program. If participants are satisfied with the program, then expansion
of the program would be justified and it
may improve medication adherence and
pharmacy workflow.
230—PATIENT
SATISFACTION
WITH PHARMACIST-LED CHRONIC DISEASE STATE MANAGEMENT
PROGRAMS. Schuessler T, Hen House,
Ruisinger J, University of Kansas School
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JAPhA e159
APhA2014 ABSTRACTS
of Pharmacy, Hare S, Balls Food Stores,
Melton B, University of Kansas School
of Pharmacy, E-mail: tyler.schuessler@
ballsfoods.com
Objective: As patients begin to realize the value of pharmacist contributions
to patient care, the number of patients
participating in pharmacist-led disease
state management (DSM) programs will
likely increase. Therefore, understanding patient needs will be central to the
success of these programs. The objective
of this study is to assess patient satisfaction with 2 pharmacist-led chronic DSM
programs.
Methods: A self-insured company,
which operates a chain of pharmacies
in the Kansas City metropolitan area,
administers its own diabetes and cardiovascular DSM programs for employees and their dependents through the
company’s health insurance plan. These
pharmacist-led programs work with
patients to improve cardiovascular and
diabetes outcomes through education,
improved medication adherence, and
drug therapy optimization. Patients are
given incentives to participate, such as
discounts on health insurance and prescription medications. This study is a
cross-sectional survey that will collect
demographic information and assess patient satisfaction with the chronic DSM
programs through a modified version
of the validated diabetes disease state
management questionnaire (DDSM-Q)
using a 5-point Likert scale. Study participants must be ≥18 years of age, an employee or dependent utilizing company
health insurance, have participated in
1 or both of the chronic DSM programs
for ≥6 months, and have either hypertension, hyperlipidemia, or diabetes.
Clinical pharmacists who administer the
program will provide a survey to program participants with a return envelope
included to be anonymously completed
at the end of the pharmacist visit. Descriptive statistics will be used to assess
patient demographics. Program satisfaction will be evaluated using chi-square
with an a priori alpha of 0.05.
Results: Research in progress. Results from this study could influence
future consideration for starting or continuing pharmacist-led chronic DSM
e160 JAPhA | 5 4:2 | M AR/AP R 2014
programs. Further, current programs
may use the data to improve patient satisfaction.
231—PSYCHOMETRIC
EVALUATION OF AN INFORMATION SEEKING AND PROCESSING INSTRUMENT: MEDICATION RISK MESSAGES IN THE MEDIA. Williams C,
Huston S, University of Georgia, Sarpong D, Xavier University of Louisiana,
study is to examine the psychometric
properties of an instrument developed
to test the Risk Information Seeking and
Processing (RISP) Model. For this study,
rosiglitazone cardiovascular risk was
used as the exemplar.
Methods: The 44-item survey comprised: (1) health history information
(physician-diagnosed diabetes, cardiovascular disease, diabetes [type 1 or 2],
diabetes medication use); (2) information
channels used for health-related information; (3) risk information seeking and
processing variables (current knowledge
of rosiglitazone cardiovascular risk, information sufficiency threshold, channel
beliefs, perceived information gathering
capacity, and seeking and processing behaviors); and (4) demographic variables.
The survey, administered via Qualtrics
online survey software tool, took approximately 30 minutes to complete.
In the development process, the survey
was pilot tested in two stages: (1) Delphi method was used to revise the initial constructed instrument; and (2) the
revised survey was tested in 10% of the
target population. The 5-response option
Likert-like scale responses to channel
belief items was 1 (most negative) to 5
(most positive); and the scale of Current
Knowledge and Information Sufficiency
(knowledge needed) was 0 to 100. Descriptive statistics, factor analysis, and
reliability analysis (Cronbach alpha)
were performed to determine the psychometric properties of the subscales of
the instrument.
Results: The 15 channel belief items,
with responses ranging from 2 to 5, had
Cronbach alpha scores ranging from
0.598 to 0.829. Of the 3 media channels, magazines had the highest (alpha
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0.818–0.821); followed by television (alpha 0.750–0.763); and newspaper (alpha
0.690–0.755). The range of alpha values
for information seeking, heuristic information processing, and systematic information processing was 0.745–0.780.
Conclusion: The instrument designed to assess the RISP Model for medication taking of patients is valid, reliable, and can be used to help understand
factors influencing information seeking
in medication risk situations.
232—WHY MEDICARE PART D
BENEFICIARIES DO NOT SWITCH
PLANS: TESTING A MODEL OF
PART D PLAN INFORMATION PROCESSING. Han J, Urmie J, University of
Iowa, E-mail: [email protected]
Objective: Guided by the Motivation, Opportunity, and Ability (MOA)
model, the objective of this study was to
describe Medicare Part D plan information processing.
Methods: This study used focus
groups and individual interviews to obtain qualitative data. Stratified purposeful sampling was used to recruit participants. Medicare Part D beneficiaries
were recruited from a church, an independent living facility, an assisted living
facility, and a senior center in 2 Iowa cities. The 2 selected areas represent higher
and lower education attainment compared with the Iowa statewide average.
In total, 17 individuals participated in
the study. Written transcripts were made
from audio-recorded discussions and
coded using the MOA model as a guide.
Results: A total of 18 themes were
identified. Information processing (low,
medium, high); perceived risk (fear
of making changes, losing coverage,
choosing wrong plan); needs (product
differentiation, product importance);
opportunity (access to helper, access to
helper with medical knowledge, social
interaction, information, choices); self-efficacy; and ability (knowledge, literacy)
matched constructs from MOA model.
Delegation of information processing
(delegation of initiating information processing, delegation of some information
processing after self-initiation) was a
newly identified theme that was not included in the MOA model. Participants
APhA2014 ABSTRACTS
from the church or senior center tended
to do nothing before receiving help with
information processing whereas those
from independent and assisted living
facilities tended to initiate information
processing. Although none of participants switched Part D plans last year,
their level of information processing was
varied; for example, some read through
plan information whereas some threw it
away.
Conclusion: The results of this study
suggest that Medicare Part D beneficiaries process plan information in various
degrees even though they made the same
decision to stay with their current Part D
plan. These results will help policy makers develop strategies to improve beneficiaries’ non-switching behaviors.
233—YOUTHS’ DIABETES EMOTIONS, EMOTION PROCESSING,
AND COMFORT IN ADJUSTING
FOR DIABETES IN PUBLIC. Huston
S, Kim C, Rathbun S, Blount R, Murray
D, University of Georgia, Heidesch T,
Brenau University, Southwood R, University of Georgia, E-mail: hustonsal@
gmail.com
Objective: This study was conducted to: (1) develop scales for measuring (a)
adaptive and negative diabetes-related
emotions of adolescents with diabetes,
(b) their emotion expression and processing, and (c) their comfort in adjusting
for diabetes in public; and (2) investigate
the relationships among the 3 sets of
variables.
Methods: Scales were tested and
validated via cross-sectional survey administration to 308 youths from 8 to 17
years of age attending a summer diabetes camp.
Results: Principal components
factor analysis resulted in the following scales: negative diabetes-related
emotions, confidence, feeling normal,
personal growth, and comfort with adjusting. Emotion expression was significantly associated with confidence, personal growth, and comfort. Talking with
friends and dad, but not with mom, was
associated with feeling normal. Emotion
processing was significantly and positively correlated with confidence, feeling
normal, personal growth, and comfort
with adjusting for diabetes in public.
Self-identifying as African American
was significantly and positively correlated with more negative diabetes emotions, and lower scores on confidence,
feeling normal, and comfort in adjusting
for diabetes in public. Being a previous
camper was significantly correlated with
more comfort in adjusting for diabetes in
public and higher confidence and personal growth.
Conclusion: Constructs of both negative and adaptive diabetes related emotions were identified. Adaptive emotions
appear to be positively associated with
comfort in adjusting for diabetes in public. African Americans appear to experience lower levels of adaptive emotion
and higher levels of negative emotions,
while camping was associated with improvements in adaptive emotions. Age
was not correlated with negative or
adaptive emotions. Interventions, such
as diabetes camps, which foster emotion expression and processing (e.g., diabetes-related emotion discussion with
friends), have the potential to improve
adaptive emotions and behaviors in
youths with diabetes. African American
youths with diabetes may especially benefit from such interventions.
Patient Care Services
group sessions at a community pharmacy. Visits occur weekly for the first month
and every other week during months 2 to
6. Patients’ weights are measured at every visit and a total body composition is
performed at the first and last visits. Patients are provided with behavioral, dietary, and nutritional education during
these visits. Furthermore, patients are
encouraged to make goals during each
visit regarding the provided educational
content. The primary outcome is the
mean weight loss at 6 months compared
with baseline. A 6-month follow-up also
will be performed with those who have
completed the program to assess the
weight loss maintenance achieved.
pharmacist-led weight loss program is
currently ongoing. To date, 11 participants have completed the study with an
additional 22 currently enrolled. For
those who have completed the program,
all participated in individual sessions
and the mean weight loss at 6 months
compared with baseline was 5 kg (95%
CI 3–6.9 kg, P<0.001). Results of the
6-month follow-up are in progress. A
pharmacist-led intensive behavioral
therapy program can effectively assist
patients in losing weight in a manner
consistent with the guidelines set forth
by CMS.
234—EVALUATION OF A PHARMACIST-LED 6-MONTH WEIGHT LOSS
PROGRAM IN OVERWEIGHT PATIENTS. Ching K, Boomershine V, Walgreens, Pogge E, Midwestern University
College of Pharmacy–Glendale, E-mail:
[email protected]
is to evaluate the efficacy of a pharmacist-led weight loss program that is based
on the general requirements set forth by
Services (CMS) November 2011 Decision
Memo for Intensive Behavioral Therapy
for Obesity.
Methods: This study is a pilot weight
loss program following the CMS guidelines. Individuals with a body mass index (BMI) >30 kg/m2 or >27 kg/m2 with
an additional comorbidity are eligible for
participation in the study. Participants
are to attend 14 face-to-face individual or
235—ADVANCING THE ROLE OF
PHARMACY TECHNICIANS: TELEPHONE HOSPITAL DISCHARGE
FOLLOW-UP. Turner P, Rodriguez Esquire A, Vera D, Fort Belvoir Community Hospital, E-mail: David.A.Vera.mil@
health.mil
Objective: This study aims to determine the feasibility of a certified
pharmacy technician (CPhT) to perform
telephone hospital discharge follow-up.
Recently hospitalized patients are at high
risk for adverse drug events (ADEs). It is
estimated that 20% to 30% of all patients
are readmitted, of which 66% are attributable to ADEs. Telephone hospital discharge follow-up has been reported to
reduce emergency department (ED) visits and hospital readmissions. Hospitals
are challenged to reduce readmissions
by providing safe inpatient care and to
minimize post-discharge complications
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APhA2014 ABSTRACTS
with limited resources.
Methods: Adults aged >18 years
discharged from the general medicine
ward from May 1 to July 31, 2013 were
contacted by a CPhT within 7 days via
telephone using a scripted medication
assessment questionnaire. Patients who
self-reported an ADE were referred to
a clinical pharmacist for evaluation and
triage. Patients were classified as “lost
to follow-up” if they did not receive a
follow-up call or telephone number was
invalid. Data collected included baseline
demographics, health care utilization,
number of patients referred to clinical
pharmacist, post-discharge ADE, CPhT
interventions, and time spent. Thirtyday readmissions and ED visits were obtained from Tricare claims data.
Results: Fifty-two patients met the
inclusion criteria for post-discharge telephone follow-up. The CPhT successfully
contacted 19 patients and completed 3 interventions (i.e., 1 booked appointment
and 2 medication refills). Telephone calls
lasted 2 to 7 minutes. Two patients were
referred to a clinical pharmacist; both
patients experienced an ADE (i.e., diarrhea attributed to new antibiotic). One
patient was readmitted for treatment of
infection. Two readmissions in the “not
contacted” arm occurred <7 and 29 days
post-discharge. In the “lost to followup,” 2 ED visits occurred 29 days postdischarge.
Conclusion: CPhTs are able to perform scripted telephone hospital discharge follow-up and effectively refer
patients needing consultation with a
clinical pharmacist.
236—ASSESSMENT OF A PHARMACIST-LED COMPREHENSIVE MEDICATION MANAGEMENT AND
WELLNESS PROGRAM. Janovick D,
Bright D, Ohio Northern University,
Green T, Kroger Co., E-mail: d-janovick@
onu.edu
Objective: Pharmacists are currently
providing comprehensive medication
management in the outpatient setting.
However, there is little documented evidence suggesting pharmacists are providing nonpharmacologic support, such
as fitness and nutrition counseling. The
objective of this study is to demonstrate
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a pharmacist-led wellness program with
medication management and lifestyle
modifications through fitness and nutrition can lead to improved biometric
markers.
Methods: The wellness program will
target corporate employees and will be
offered in a corporate headquarters setting with an on-site workout facility. The
pharmacist overseeing the program will
be licensed as a certified personal trainer
from the National Strength and Conditioning Association for fitness program
design and supervision. The program
is expected to recruit approximately
40 patients into the wellness program
consisting of 2 treatment arms from November 2013 to May 2014. Group A will
feature nutrition-based classes, medication therapy management, and fitness
education. Group B will perform the first
group’s activities plus direct, supervised
fitness training once weekly. Measured
outcomes during the study will consist
of body mass index, waist circumference,
fasting blood glucose, blood pressure,
heart rate, and lipid panel. Biometric
markers will be assessed at baseline, 3
months, and 6 months. Comparisons will
be made using Microsoft Excel 2010 and
SPSS v18.0. This study will be submitted
for institutional review board approval.
237—BLOOD PRESSURE MONITORING BY ADVANCED PRACTICE
STUDENT PHARMACISTS TO ASSESS PATIENTS’ GOALS OF THERAPY. Doheny S, Walgreens, Charron D,
Massachusetts College of Pharmacy and
Health Sciences University, Oh S, Walgreens, Lynch A, Massachusetts College
of Pharmacy and Health Sciences University, E-mail: [email protected]
is to determine the impact of a monthly
blood pressure screening protocol on
student pharmacists’ knowledge of hypertension, their confidence in assessing
blood pressure, and the appropriateness
of their treatment plan.
Methods: Advanced pharmacy
practice experience (APPE) students will
be assessed prior to involvement in rotation activities on their knowledge of hypertension and goals of therapy. During
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their rotation, students will participate
in a monthly blood pressure screenings
at their APPE site to eligible and willing
patients. Students will then assess a patient’s blood pressure and design a treatment plan (if necessary) in addition to
other rotation responsibilities. Change in
scores of students’ hypertension knowledge before and after the rotation will be
reported as well as their perception of
confidence in assessing blood pressure,
and the appropriateness of their treatment plan. The students’ knowledge of
hypertension and treatment guidelines,
confidence in assessing blood pressure,
and appropriateness of treatment recommendations will be compared with 2
cohorts: (1) APPE students on the same
rotation who do not participate in the
monthly blood pressure screenings and
(2) APPE students on a similar rotation
with a different preceptor. The appropriateness of their treatment plan will be
assessed by their preceptor at the time of
patient visit, and is determined on current treatment guideline recommendations and patient-specific factors.
Results: Research in progress. Patient recruitment and student assessment is ongoing.
Q 238—BREAKING THE TRICARE
MAIL ORDER PHARMACY BARRIER WITH PATIENT EDUCATION.
Weber S, Oliver D, Naval Health Clinic
Charleston, E-mail: samantha.weber@
med.navy.mil
Objective: The Tricare Mail Order
Pharmacy (TMOP) program, administered by Express Scripts, is designed to
provide beneficiaries their medications
when they need them. The Naval Health
Clinic Charleston (NHCC) Pharmacy
Process Improvement Committee recognized a need to better serve patients
who presented prescriptions that were
designated non-formulary. Currently
there are no copayments to beneficiaries processing prescriptions at military
treatment facilities (MTFs). As of February 2013, TMOP copayments range from
$0 to $43, and current retail pharmacy copayments range from $15 to $132 for a 90day supply. Seeing the need and benefit,
not only for beneficiaries but also for the
Department of Defense, the pharmacy
APhA2014 ABSTRACTS
team decided to educate and assist patients with the enrollment process. The
objective is to enhance patient quality of
care through the use of TMOP services.
This is an effort to allow patients to receive the best quality of care that can be
rendered by the facility for medications
not available on local MTF formulary.
Methods: Initial determinations
were made whether the patient was currently using TMOP services for those
medications not on the local MTF formulary. When patients were unaware or
not currently using TMOP services, they
would be counseled on the benefits and
assisted with the initial enrollment process. Afterward, the patients would be
asked to complete a short survey to determine if they felt TMOP was improving their quality of care.
Results: Over the past 5 months,
there have been 107 patients enrolled in
TMOP. Of the 107 patients enrolled, 300
prescriptions have been filled through
TMOP, resulting in a total cost savings of
$39,447 to the government.
Conclusion: Medication costs appear to be one of the most common barriers to health care. The pharmacy has
stepped in and identified that TMOP education was a barrier inhibiting NHCC’s
patient populations’ access to care and
then provided the services necessary to
overcome those barriers, which resulted
in the improvement of quality of care.
The NHCC pharmacy TMOP assistance
program has proven to be a step in the
right direction in breaking the TMOP
barrier and improving patient education. This in turn leads to a better quality
of care for those patients entrusted to our
care.
Original Citation: Breaking the tricare mail order pharmacy “TMOP” barrier with patient education.
239—COMPARISON
OF
TWO
PHARMACIST-DRIVEN POPULATION MANAGEMENT APPROACHES TO INCREASE MONITORING OF
SERUM VITAMIN B12 IN PATIENTS
TAKING METFORMIN. Matthews D,
Beatty S, The Ohio State University College of Pharmacy, Grever G, The Ohio
State University, LaBella S, The Ohio
Lehman A, The Ohio State University,
Barnes K, The Ohio State University
College of Pharmacy, E-mail: [email protected]
of this project is to compare 2 pharmacist-driven population management
approaches to improve monitoring of
serum vitamin B12 in patients taking metformin. Secondary objectives are to: (1) determine the number
of patients on metformin with a vitamin
B12 deficiency; and (2) determine the number of patients on metformin with a vitamin B12
deficiency and prior evidence of anemia
or peripheral neuropathy.
Methods: The electronic medical
record will generate a list of patients
on metformin who are enrolled in
MyChart, a secure patient portal that allows electronic communication between
health care providers and patients. Patients taking metformin for at least 1
year who have not had serum vitamin
B12 monitoring completed
in the past year will be randomized to 1 of
2 population management interventions.
For patients randomized to approach 1,
the pharmacist will communicate monitoring recommendations to the primary
care physician prior to a scheduled office visit. For patients randomized to approach 2, the pharmacist will communicate the need for laboratory monitoring
directly to the patient using MyChart.
Charts of patients in both groups will be
reviewed 30 days after the initial communication to track the increase in serum
vitamin B12 monitoring
and the number of patients with vitamin
B12 deficiency. Retrospective chart reviews of patients with vitamin B12 deficiency will be
performed to determine the number of
patients with prior evidence of anemia or
peripheral neuropathy.
Results: Research in progress. Descriptive and inferential statistics will
be used to describe the difference in the
proportion of patients in each group who
obtained serum vitamin B12 measurements. The number of patients with a vitamin B12
deficiency who have prior evidence of
anemia or peripheral neuropathy will be
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reported. The time spent by the pharmacist to conduct each intervention also will
be reported to characterize the long-term
sustainability of each approach.
240—A COMPREHENSIVE REVIEW
OF CURRENT PROCEDURAL TERMINOLOGY CODES TO ASSESS
PHARMACY’S CURRENT AND FUTURE ROLE IN HEALTH CARE. Kurian J, Jennings L, Asfoor F, Dichoso E,
Luu D, Tabrizi P, Tasmin A, Tauscher T,
University of the Pacific, Thomas J. Long
School of Pharmacy and Health Sciences,
Objective: The Current Procedural
Terminology (CPT) codes were used as
a model of contemporary health care to
investigate which services pharmacists
are licensed to perform and potentially
bill for these services.
Methods: The guidelines for a doctor of pharmacy degree (PharmD), according to the Accreditation Council
for Pharmacy Education (ACPE), and
5 Board of Pharmacy Specialties (BPS)
were reviewed and compared with each
individual CPT code. The CPT codes
that were represented by a guideline
were compiled by 2 separate researchers. Cohen’s kappa test was utilized to
determine the inter-rater reliability. Any
discrepancies were then reviewed by the
pair of researchers to produce a final list
of codes that fell under the specified set
of guidelines.
Results: There are 10,962 CPT Category I codes within the 2013 CPT code
list. A total of 672 CPT Category I codes
were determined to be represented by
the PharmD degree ACPE guidelines.
The percentage of CPT Category I codes
that are represented by each specialty’s
guidelines, in addition to the baseline
PharmD codes, are 6.90% (Psychiatry),
7.64% (Nuclear), 7.31% (Oncology) ,
6.27% (Nutrition Support), 8.06% (Ambulatory Care), and 8.46% (Pharmacotherapy). The number of CPT Category
I codes that are represented solely by
each specialty’s guidelines are 108 (Psychiatry), 167 (Nuclear), 131 (Oncology),
76 (Nutrition Support), 424 (Ambulatory
Care), and 655 (Pharmacotherapy).
Conclusion: This review exemplifies
the significant presence of pharmacists
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APhA2014 ABSTRACTS
in the current health care system beyond
the 3 CPT codes designated to pharmacists, notably in Pharmacotherapy and
Ambulatory Care specialties. The future
of pharmacy lies in optimizing the role of
the pharmacist within the patient-centered medical team. Shifting services to
pharmacists can allow other health care
providers to tend to additional patients
whose needs are not presently met under
the current health care structure, potentially reducing health care costs and optimizing quality of care.
241—COST ANALYSIS AND EVALUATION OF PATIENT AND PROVIDER SATISFACTION OF PHARMACIST-DELIVERED
TRAVEL
HEALTH SERVICES IN A COMMUNITY PHARMACY. Ford M, University of Iowa, Kading T, Hy-Vee, Ernst
E, Veach S, University of Iowa, E-mail:
[email protected]
determine whether pharmacist-delivered travel health services, excluding
immunizations, would be cost-effective
if reimbursed using a two-level, tripletier payment system; and (2) evaluate
patient and provider satisfaction with
pharmacist-delivered travel health services.
Methods: This will be a prospective, observational study in a Midwest
grocery store chain pharmacy. The pharmacist will document time spent gathering recommendations from the Centers
for Disease Control and Prevention and
counseling on general travel information
for patients who present for travel health
services from October 2013 through February 2014. The patient will be charged a
fee similar to a physician office visit insurance copay for the consultation. For
study purposes, a two-level, triple-tier
system will be used for data collection.
Level 1 will correspond to the number
of countries visited (Tier 1 is 1–2 countries, Tier 2 is 3–4 countries, and Tier 3 is
≥5 countries). Level 2 will correspond to
pharmacist time (Tier 1 is ≤30 minutes,
Tier 2 is 31–60 minutes, and Tier 3 is >60
minutes). Each visit will be assigned a
fee based on the highest categorized tier,
whether it is Level 1 or Level 2. The dollar value assigned per tier will be $150
e164 JAPhA | 5 4:2 | M AR/AP R 2014
for Tier 1, $175 for Tier 2, and $200 for
Tier 3. A cost analysis will be done for
data collected during the study period
to determine whether the service is costeffective. Surveys using a 5-point Likert
scale will be sent to past and current
travel health patients and providers who
have been contacted for prescriptions related to travel. The questions will assess
overall satisfaction and perceived value
of the service, areas for quality improvement, and confidence in the pharmacist’s
recommendations (for providers only).
Descriptive statistics will be used to report results.
242—DEVELOPMENT OF AN INDEPENDENT THIRD-YEAR STUDENT
PHARMACIST ROTATION IN PEDIATRIC ASTHMA CLINICS. Qureshi
A, Kittaneh A, The Ohio State University, Laubacher C, Nationwide Children’s
Hospital, Singrey A, Rodis J, The Ohio
State University, E-mail: [email protected]
study are to: (1) implement an independent, introductory pharmacy practice
experience (IPPE) for third-year (P3)
student pharmacists in pediatric asthma
ambulatory clinics; (2) assess students’
perceptions regarding experience; and
(3) assess satisfaction of families receiving education.
Methods: P3 students provide asthma-focused patient education independent of a pharmacist at 3 pediatric primary care clinics 1 half day per week during
the 2013–14 academic year as part of an
IPPE. An ambulatory care clinical pharmacist trains students using the interactive, case-based Pharmacy Student Asthma
Learning and Training manual created
by the pharmacy preceptor. During 4
half-day clinics, the physician precepts
the student to provide education to patients and families using materials such
as an asthma education booklet, patientfriendly medication handouts, and training devices for demonstration purposes.
After the visit, the family completes a
written satisfaction survey, dropping the
completed document at the front desk to
maintain confidentiality. Student feedback regarding the IPPE is evaluated usja p h a .org
ing a survey completed at training and
on the last day of rotation to compare
pre- and post-rotation perspectives. Information gathered evaluates students’
perceptions of the value of this learning
experience, comfort working independently, confidence providing education,
and areas for improvement. Information
is analyzed using descriptive statistics.
Results: Research in progress. Preliminary data presented will include
the number of patients educated by
students, patient demographics, family
satisfaction with the service, and student
pre- and post-rotation perceptions of the
IPPE. This IPPE in pediatric ambulatory
care affords P3 students a unique opportunity to improve interdisciplinary
skills, develop the ability to work independently, and enhance pharmacologic
and therapeutic knowledge. Investigators aim to provide a template for pharmacists in similar settings seeking to enrich students’ experiences.
243—EFFECTIVENESS OF A COMMUNITY
PHARMACIST–PROVIDED WEIGHT MANAGEMENT
PROGRAM. Fina P, Danaher V, New
Albertsons Inc., Winkler S, Midwestern
University Chicago, Wagner M, New
Albertsons Inc., E-mail: [email protected]
is to determine the effects of a community pharmacist–provided weight management program on patient weight,
waist circumference, and body mass
index.
Methods: A pharmacist-provided
weight management program will be
implemented at 3 pharmacies within
a supermarket pharmacy chain. Subjects will be identified during annual
employee wellness screenings. Inclusion criteria are: associate or spouse
with company-provided insurance, ≥18
years of age, nonpregnant, and body
mass index ≥25.0 kg/m2. Subjects will
participate in a pharmacist-provided
12-week weight management program.
Blood pressure, total cholesterol, highdensity lipoprotein, and random blood
glucose will be measured at baseline and
12 weeks. Pharmacists will perform a
targeted medication review at baseline
APhA2014 ABSTRACTS
to track and intervene on medications
known to cause weight management
difficulty. Subjects will meet bi-weekly
with a pharmacist for a total of 7 visits,
which will alternate between live and
telephone consultations. Each consultation will include targeted education on
selected topics, such as setting goals,
reading nutrition labels, and planning
meals. Every subject’s waist circumference and weight will be measured during the live consultations. Descriptive
statistics will be used to assess changes in
the patient population after participation
in the weight management intervention.
Results: Research in progress. Obesity has been increasing in prevalence in
the United States from 12.8% in 1960, to
22.5% in 1994, to 35.7% in 2010, and the
American Medical Association has declared it a disease. This trend is alarming, as studies have shown that obesity
is a serious health condition that leads to
increased morbidity and mortality. Data
from this study will help to determine
the effect a pharmacist can have on patient outcomes in a community pharmacist–provided weight management program. Further, the methods used may
provide a foundation for future weight
management programs in the community pharmacy setting.
244—EVALUATING THE EFFECT OF
THE APPOINTMENT-BASED MODEL ON INCREASING MEDICATION
THERAPY MANAGEMENT INTERVENTIONS AND INFLUENZA IMMUNIZATION RATE IN A COMMUNITY PHARMACY. Martin A, University of Iowa College of Pharmacy, Shepley A, Jackson A, Wilkinson K, CarePro
Health Services, Tang Y, Veach S, University of Iowa College of Pharmacy, Email: [email protected]
Objective: Pharmacists face many
barriers to providing medication therapy
management (MTM) and immunization services in a community pharmacy.
The appointment-based model (ABM)
is a program that allows medication
synchronization to a monthly appointment date and may decrease barriers to
providing those clinical services. The
objectives of this study are to compare
pre- and post-enrollment MTM interven-
tions identified by pharmacists and rates
of influenza immunization administered
at the pharmacy in patients enrolled in a
pharmacy’s ABM medication synchronization program.
Methods: This is a prospective, pilot
project being implemented at a community pharmacy in a small, rural, Midwest
community. Patients with >5 medications will be flagged during the dispensing process and targeted for enrollment
into the ABM synchronization program
by pharmacy staff using promotional
material. In order to synchronize medications to 1 monthly appointment, patients will agree to monthly prescription
reminder phone calls, receipt of preliminary partial fills, and payment of corresponding copayments. Enrolled patients
will be contacted by phone 1 week before
the monthly appointment, using a standardized script to inquire about needed
refills and scheduling an influenza vaccination. All requested medications will
then be filled at a convenient time for
pharmacy staff prior to the appointment.
Enrolled patients’ medication profiles
also will be reviewed for potential MTM
interventions prior to the appointment.
At the appointment, pharmacists will
make and document MTM interventions as well as any required follow-up.
If patients are OutcomesMTM eligible,
a claim will be submitted using the OutcomesMTM online platform. MTM interventions, OutcomesMTM claims, and
influenza vaccination rates for enrolled
patients pre- and post-intervention will
be reported using descriptive statistics.
245—EVALUATING THE IMPLEMENTATION OF YEAR-AROUND
IMMUNIZATIONS IN A GROCERY
STORE CHAIN PHARMACY. Binz J,
University of Arkansas for Medical Sciences, E-mail: [email protected]
study are to: (1) evaluate the implementation of a year-around immunization
program in a community pharmacy by
assessing the cost of implementation and
return on investment (ROI) as well as the
effect on pharmacy business growth; and
(2) justify the implementation of clinical
services in a community pharmacy set-
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ting.
Methods: Design: Retrospective
study. Setting: Twenty-eight pharmacies in a grocery store chain in Arkansas
implemented an immunization program
to provide year-around immunizations
(i.e., zoster [shingles], pneumococcal,
and influenza vaccinations). The program’s implementation was led by the
community pharmacy resident. All
stores began the program on September
16, 2013. Patients: Pharmacy patients.
Data: Data were collected retrospectively
using the Enterprise pharmacy system to
include data from the time of implementation (September 16, 2013) through February 16, 2014. Data from previous years
also were obtained using the Enterprise
system. Data Analysis: The cost of implementation, ROI, profit per immunization, and the service’s effect on business
growth were evaluated. The cost of implementation was tabulated throughout
the implementation and then calculated
as the sum of all costs involved in implementing the program (cost of pharmacist
training/certification, resident salary,
supplies, etc.). Following the collection
of data and cost of implementation, the
ROI was evaluated. ROI was calculated
using: ROI = (revenue from investment
– cost of investment)/cost of investment.
A positive number would indicate a
profitable program. The average profit
per immunization was determined after
calculating the profit for each immunization using: profit = revenue – cost. Lastly,
the service’s effect on business growth
was evaluated. Each store’s growth during this time frame was compared with
the growth rate in the previous 3 years.
The growth rate was measured as a
change in pharmacy sales between September and February of each year.
246—EVALUATION OF COMMUNITY PHARMACIST COMMUNICATION STRATEGIES TO IMPACT
BEHAVIOR CHANGE IN AN EMPLOYEE WELLNESS PROGRAM.
Ventricelli D, West Virginia University,
Rumbach-Austin J, Kroger, Elswick B,
West Virginia University, E-mail: [email protected]
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JAPhA e165
APhA2014 ABSTRACTS
study are to: (1) determine the degree of
short-term behavior change in patients
who enroll in an employee wellness program; and (2) assess whether differences
exist between pharmacist-provided telephone communication versus electronic
mailings to employees regarding company-determined health targets.
Methods: This is a prospective,
open-enrollment,
quasi-experimental
study conducted within a grocery store
chain in 22 locations. Participants who
received a company-provided health
screening during a 3-month period and
who are >18 years of age will be included
in this study. Participants who received
a health screening from a health care
source outside the company will be excluded. Following a pharmacist-administered comprehensive health screening
program for blood pressure, blood glucose, body mass index, and cholesterol,
employees who do not meet the company health targets will be identified for additional pharmacist-provided education
and employee wellness programs. These
participants will be randomly assigned
to an intervention or control group. Participants assigned to the control group
will receive standard electronic communication from the company directing
them to the wellness program opportunities that are available. The intervention
group will receive the same electronic
communication as the control group.
In addition, the intervention group will
receive a personalized phone call from
their pharmacist to explain the wellness
program options available to them. All
participants will be contacted by phone
after 3 months to determine whether
they made any behavior change to assist
them in attaining personal health goals.
Data will be analyzed to determine
whether there is any difference in behavior change between the intervention
group and the control group.
247—EVALUATION OF A DISCHARGE MEDICATION BEDSIDE
DELIVERY PROGRAM: THE PATIENT PERSPECTIVE. Yum C, Poliskey K, McPhillips A, Walgreen Co., Rickles N, Northeastern University, E-mail:
[email protected]
e166 JAPhA | 5 4:2 | M AR/AP R 2014
Objective: A large community chain
pharmacy located inside a clinic has
implemented a pilot program to deliver
discharge medications to patients’ bedside upon discharge from a large urban
hospital. The purpose of this program is
to provide patients immediate access to
their discharge medications and avoid
initial and medication nonadherence related to medication non-availability. Utilizing the PRECEDE-PROCEED planning model, this study aims to evaluate
the pilot bedside delivery program and
identify ways to make the program more
efficient and effective and to maximize
several patient outcomes.
Methods: This study has 2 components. First, a retrospective descriptive
analysis of patients enrolled in the program from January 2013 to September
2013 will be conducted. The analysis
will examine patient demographics such
as: age and sex, prescription insurance
status, number and type of medications
brought to bedside, patient’s residential
distance from hospital, and whether the
patient received a follow-up phone call
48 to 72 hours post discharge. The second component involves a survey given
to patients enrolled within a 3-month
period. At time of consent, patients will
be given a choice to receive the survey
via telephone, Internet, or postal mail.
Patients will be contacted approximately 1 month post discharge and survey
questions will explore self-reported
adherence to the medications received
at discharge, primary care provider
follow-up, patient satisfaction and helpfulness with the existing program, and
exploration of unfulfilled medication
needs at discharge. Descriptive statistics will be used to analyze most patient
survey items. Thematic analysis will be
used to analyze open-ended items from
patient surveys. Exploratory bivariate
and multivariate analyses will be used to
examine relationships between program
characteristics and patient outcome variables. All data will be entered and analyzed using SPSS 21.0.
Results: Research in progress. Institutional review board approval is pending from affiliated sites.
248—AN EVALUATION OF A PHARja p h a .org
MACIST’S IMPACT ON THE AVOIDANCE OF ADVERSE DRUG EVENTS
WHEN PROMPTED BY A THIRDPARTY PAYER COMMUNICATION.
Grant K, Gwin R, Johnson A, Teplitskaya
A, McConaha J, Lassila H, Duquesne
Objective: This study aims to assess
the impact of interventions made by a
pharmacist embedded in a primary care
physician office, when prompted by a
third-party payer, on physician cost savings and satisfaction.
Methods: A clinical pharmacist,
based in a primary care physician office,
reviewed weekly patient care communications sent by third-party payers. Medicare, Medicaid, and commercial thirdparty payers sent communications to notify physicians of potential patient medication-related issues. These alerts often
included recommendations for gaps in
care according to published guidelines,
medication adherence issues, and potential drug-drug or drug-disease interactions. These communications were analyzed by the physician practice’s clinical
pharmacist and were either resolved at
the pharmacy level or a recommendation was made to the physician. Documented data from this initiative included
whether or not the recommendation was
accepted, how the issue was able to be resolved (by the pharmacist or physician),
and physician-reported satisfaction with
the service.
Results: Research in progress. Preliminary results show that the majority of
the care management alerts were able to
be resolved by the pharmacist. Qualitative analysis of physician-reported benefits of the service in terms of satisfaction
and time savings also will be analyzed.
249—EVALUATION OF STUDENT
PHARMACIST AND PHARMACIST
IMPACT ON DISEASE STATE MANAGEMENT AND PATIENT SATISFACTION IN ADULT PATIENTS
WITH ASTHMA. Jackson B, McConaha J, Duquesne University, E-mail: [email protected]
was to measure the success of student
pharmacist intervention, with pharmacist oversight, on improvements in dis-
APhA2014 ABSTRACTS
ease state control and patient satisfaction
in an adult population with asthma.
occurred at a regional chain community
pharmacy, an independent chain pharmacy, and a university campus located
in Pittsburgh, Pennsylvania. Patients
aged 18 to 65 years with a diagnosis of
asthma on ≥1 inhaled medications were
included. Three interventions were
utilized: an initial face-to-face intervention, a follow-up face-to-face intervention 1 month after the initial visit, and a
telephonic follow-up 6 months after the
initial visit. Asthma severity and control were determined for each patient
enrolled in the study through the use of
multiple assessments including spirometry testing, inhaler technique reviews,
validated surveys such as the Asthma
Control Test (ACT), and patient satisfaction questionnaires. The main outcomes
measured in this study were patient
confidence level with disease state management and improvement in inhaler
technique following student pharmacist
intervention.
Results: After 6 months of recruitment, 12 patients were enrolled and 6
completed all interventions (50%). Data
measured included spirometry values,
survey responses, and inhaler technique
review scores and was analyzed using a
repeat-measures ANOVA. An average
ACT score of 19.8 (out of 25; 79.2% controlled) was noted at baseline, with 22.2
(88.9% controlled) post-intervention.
Patient inhaler technique improved at 1
month, from an average technique score
of 77.8% to 94.4%. Patient satisfaction
with disease state control also improved
post-intervention, from an average score
of 92.3 to 110.2 (possible 126 points). The
only area where scores remained relatively unchanged was the pulmonary
function tests.
show improved patient confidence in
asthma control after student pharmacist
intervention. This type of intervention
could easily be performed by a student
intern or pharmacist in a community setting.
250—EXPLORING THE USE OF
HEALTH INFORMATION TECH-
NOLOGY IN COMMUNITY PHARMACY FOR DISSEMINATING EVIDENCED-BASED TOBACCO CESSATION SUPPORT FOR PATIENT
SMOKERS. Patel S, Ogunsanya M, Ford
K, College of Pharmacy, The University
of Texas at Austin, E-mail: [email protected]
Objective: The study was designed
to explore pharmacy professionals’ perceptions of systems changes by using
health information technology (HIT) for
expanding the reach of tobacco cessation
support for smokers.
Methods: A qualitative research design was employed using a 90-minute
focus group with community pharmacy
professionals (CPPs) from Texas. Building from the Theory of Planned Behavior
(TPB) model, participants were asked to
respond to questions based on the following constructs: (1) behavioral beliefs–
describe the advantages and disadvantages of HIT; (2) normative beliefs–identify individuals that would approve or
disapprove of a systems change; (3) control beliefs–describe factors that would
make it easy or difficult to implement
this change. Two researchers independently corroborated the order and frequency of each theme to establish interrater reliability.
Results: A total of 9 CPPs participated in the focus group. The majority
of CPPs were female (n = 7, 78%). Participants were 25 to 65 years of age. All were
board-certified CPPs practicing in Texas
and 5 (56%) were pharmacy managers.
They stated advantages associated with
HIT as: (1) speed of use; (2) proactive disease management; and (3) information
sharing. They described disadvantages
as having: (1) lack of systems support; (2)
lack of provider cooperation; and (3) lack
of legal integration. Control beliefs were:
(1) pharmacist-patient trust; (2) privacy
of patient information; (3) time; and (4)
reimbursement for services. Participants
indicated managers, corporations, hospitals, and payers as parties that would
approve or disapprove of such a systems
change. Inter-rater reliability was high
(95.5%) and discrepancies (4.5%) were
resolved through discussion. The results
of this study will help in implementing tobacco cessation support services
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in community pharmacies. The themes
identified are important focus points for
any type of pilot study that would be developed for HIT-based cessation support
in a community pharmacy.
251—IDENTIFYING
BARRIERS
THAT PREVENT OFFICE-BASED
PRACTITIONER REFERRALS FOR
COMMUNITY PHARMACIST-LED
DIABETES
EDUCATION
PROGRAMS. Mencia J, Patel C, Wagner M,
Jewel-Osco, Drambarean B, University
of Illinois at Chicago, E-mail: Jasmine.
[email protected]
is to determine the barriers preventing
office-based referrals for educational and
clinical diabetes services provided by
community pharmacists.
multicenter, survey-based study. The
top 100 prescribers will be identified in
3 different regions of the Chicago metropolitan area and contacted via fax to
complete a survey. Data collected will include: demographics, knowledge about
the role of the clinical specialist, knowledge about community pharmacist-led
diabetes education programs, types of
patients likely to be referred into these
programs, and barriers to referrals, if applicable. The survey will be available to
participants for 6 weeks and completed
anonymously. Study data will be interpreted through descriptive and comparative statistics.
Conclusion: Research in progress.
The results of this study will be instrumental in determining barriers that may
prevent office-based practitioner referrals, which will allow pharmacists to
implement methods to increase diabetes
education provided to patients in the
community setting. Based on the findings from this research, it is anticipated
that new strategies can be developed to
strengthen interprofessional relationships between community pharmacists
and office-based practitioners, further
enhancing patient care.
252—IMPACT OF CLINICAL PHARMACY SERVICES INTEGRATION
WITHIN A PATIENT-CENTERED
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APhA2014 ABSTRACTS
MEDICAL HOME. Malinowski J,
Wilkes University, E-mail: [email protected]
study are to: (1) describe a potential
role for pharmacists within a patientcentered medical home (PCMH) model;
(2) discuss successful implementation strategies and potential barriers to
pharmacist integration within a PCMH;
and (3) outline the impact of a clinical
pharmacy–integrated interprofessional
team-based model on chronic disease
outcomes.
Methods: Design: Prospective, institutional review board approved. Inclusion criteria for chronic disease focused
on completed outcomes include: 47 highrisk patients >75 years of age with recent
blood pressure >140/90 mm Hg on 2
consecutive occasions with ≥5 chronic
diagnoses and 43 high-risk patients on
multiple medications aged 18 to 75 years
with hemoglobin A1C >9%. Additional
population of focus includes patients
with heart disease and diabetes with
low-density lipoprotein (LDL) concentrations >100 mg/dL. Process: The clinical pharmacy team completed medication reconciliation and medication management reviews during chronic care
visits. Follow up: The clinical pharmacy
team and other interprofessional team
members identified monthly rapid cycle
processes or Plan-Do-Study-Act cycles to
enhance patient care. Medical residents,
pharmacy, and nursing students supported the initiative.
Results: Within 4 months, half of
all patients with hypertension aged ≥75
years achieved goal blood pressure.
Two-thirds of the population achieved
goal blood pressure within 6 months.
One-third of all patients with baseline
hemoglobin A1C >9% were under 9%
within 6 months. The average rate of potential and actual adverse events identified and corrected by the pharmacy team
was 2.8 per patient. Intervention types
will be characterized and presented. Interim LDL goal achievement and safety
evaluation in the heart disease and diabetes population will be reported.
Conclusion:
Interprofessional
team-based care with integrated clinical pharmacy services improves patient
e168 JAPhA | 5 4:2 | M AR/AP R 2014
outcomes and safety. Identification of
innovative practice models that include
pharmacy services is important for care
transformation in the PCMH setting.
253—THE IMPACT OF IMPLEMENTING OSTEOPOROSIS SCREENING
WITHIN THE COMMUNITY PHARMACY SETTING ON PATIENT EDUCATION AND RISK AWARENESS.
Mwangi W, Pope N, Lawson K, Wilson
J, The University of Texas at Austin
College of Pharmacy, Montemayor D,
Valdez G, Cervantes J, H-E-B, E-mail:
[email protected]
Objective: This project is designed
to assess the impact of community pharmacy–based osteoporosis screening on
raising awareness of risk factors, providing effective education, and enabling lifestyle modifications. Osteoporosis affects
over 10 million individuals in the United
States; the incidence of compromised
bone strength will continue to grow
as risk factors become more prevalent
within the general population. The National Osteoporosis Foundation asserts
that the identification and education of
patients at risk for osteoporosis can lead
to early treatment and prevention of disease. Screening within the community
provides an ideal setting to provide individuals with accessible education and
recommendations for bone health.
Methods: The study will be submitted to the institutional review board for
approval. Osteoporosis screening will be
offered within the community pharmacy
setting upon attaining informed consent from each participant. Participants
will complete a questionnaire to assess
modifiable and non-modifiable risk factors for osteoporosis. Based on responses
to the risk assessment tool, patients will
be educated on any identified risks and
given suggestions for lifestyle modifications. All participants will receive education on the appropriate supplements for
their respective age group and they will
be encouraged to speak with their health
care provider about osteoporosis at their
next visit. Patients who are deemed to
be at high risk for osteoporosis will be
referred to their health care provider for
confirmatory diagnostic testing. All participants will be contacted to complete a
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telephone survey assessing the services
provided through the screening, any
resulting modifications to lifestyle, and
incidence of follow-up with a health care
provider.
254—THE IMPACT OF AN INCENTIVIZED,
EMPLOYER-DRIVEN,
PHARMACIST-RUN, KNOW YOUR
NUMBERS CLINIC. Franks K,
Duquesne University Mylan School of
Pharmacy, Higginbotham S, Duquesne
University Center for Pharmacy Care, Email: [email protected]
study is to demonstrate the impact of
an employer-directed, incentivized,
pharmacist-managed wellness program
on employee total cholesterol, high-density lipoprotein (HDL) cholesterol, body
mass index (BMI), and diastolic blood
pressure (BP) from baseline along with
health literacy and knowledge about
wellness.
Methods: The study is a retrospective chart review with prospective survey conducted at a pharmacist-managed ambulatory care clinic located on
a university campus. Subjects will be
university employees with active university health insurance who participate
in the university’s Know Your Numbers
Clinic. Patients must be ≥18 years of age
or with a minimum of 2 years’ worth of
data to provide a baseline and follow-up
reading. The research is looking for an
improvement in total cholesterol, HDL,
BMI, and BP from baseline. The survey
will collect data pertaining to current
views, health literacy, and knowledge of
wellness.
Results: The data collected include
143 participants. The mean age was 50.7
years and 58 participants (40.5%) were
also enrolled in an additional program at
the clinic. The preliminary results from a
repeated measures analysis of variance
shows that an improvement was seen
with total cholesterol (P = 0.014) and
low-density lipoprotein cholesterol (P =
0.002). All other results were not statistically significant. The study aims to show
the benefit of a pharmacist-run clinic on
patient health awareness and health outcomes using point-of-care tests. While
APhA2014 ABSTRACTS
the results for most laboratory tests were
not statistically significant, they show
clinical significance. A trend was shown
in improved patient outcomes which
helps to show the benefit of pharmacist
education on patient wellness. In addition, this study aims to show value of
clinical services offered to patients without chronic conditions.
255—IMPACT OF AN ONLINE PROGRAM TO IMPROVE PHARMACISTS’ SKILLS AND CONFIDENCE
IN PROVIDING PATIENT CARE.
Farrell B, Archibald D, Tsang C, Bruyere
Research Institute, Richardson T, Canadian Pharmacists Association, E-mail:
[email protected]
is to examine the self-reported experience of pharmacists who have completed the online learning program Adapting Pharmacists’ Skills and Approaches
to Maximize Patients’ Drug Therapy
Effectiveness (ADAPT). The goal is to
determine if skills and confidence gains
have been maintained and translated
into adoption of expanded scope of practice activities and billable patient care
services, improved quality of patient
care, and professional growth. ADAPT
is a 5-month continuing education program consisting of 7 modules designed
to enhance pharmacists’ patient care and
collaborative skills. The program’s pilot
results demonstrated learner satisfaction, increased confidence in performing
skills, and gains in knowledge of skills
along with intention to change practice.
Program uptake has been significant
across Canada with growing interest
from the United States.
Methods: The study will use a
mixed-methods approach, employing a
survey, complemented with telephone
interviews. Participants include Canadian and American pharmacists who have
completed the ADAPT program since
its inception in 2011 (approximately 240
pharmacists). The survey will be analyzed using descriptive and comparative
analyses with a content analysis of openended responses. Twelve to 15 interview
participants will be purposively selected
from survey responders. Interviews will
be conducted using a semi-structured
approach, audiotaped, transcribed, and
analyzed using a constant comparative
approach.
study will generate knowledge about
the experience of ADAPT graduates attempting to employ new patient care
skills in practice. Data collection and
analysis will take place from November
2013 to February 2014. The findings will
provide insight into pharmacists’ ability to use new patient care knowledge
and skills in adopting practice change.
Barriers and other facilitators of interest
to managers and policy makers may be
identified. Researchers will benefit from
an enhanced understanding of pharmacists’ opinions about how their gains in
skills and confidence have impacted on
patient care.
256—IMPACT OF STUDENT PHARMACIST INTERVENTION ON HOSPITAL CONSUMER ASSESSMENT
OF HEALTH CARE PROVIDERS
AND SYSTEMS COMMUNICATION
ABOUT MEDICATION SCORES.
D’Angelo R, Meny L, Ferris State University, E-mail: [email protected]
project is to analyze the effect of student pharmacist–provided medication
education on the hospital consumer assessment of health care providers and
systems (HCAHP) domain of communication about medications for patients on
the medical/surgical unit at a small rural
community hospital.
Methods: The institutional review
board determined this project to be exempt from review because it was viewed
as a quality improvement initiative.
Student pharmacists at a small community hospital under the supervision of
the staff pharmacists identified patients
whose length of stay reached a duration
of 1 day by 0700 the following morning.
Students reviewed patient charts and
identified new medications not previously prescribed in the outpatient setting. Patients with high-risk medications
and/or high-risk disease states were
identified as needing medication education. Counseling points for medications
and/or disease states were developed
under guidance of the staff pharmacist.
j apha.org
Student pharmacists then met each patient and communicated indication for
new medication(s), side effects, monitoring parameters, and beneficial lifestyle
modifications. Students documented
questions from the patient and reviewed
them with a pharmacist to develop answers and reported back to the patient
with answers. Each month the institution
released data gathered by a third-party
group that administered and collected
HCAHP surveys. Reports were collected
during January through April 2013 to establish a baseline score for “communication about medication ” domain. Reports
were collected during May through July
2013. The difference from the pre-intervention period and the intervention period will be measured to analyze the effect
student pharmacists had on those scores.
average communication about medication HCAHP score for the pre-intervention period was 68.5%. Twenty-four
patients during the intervention period
were identified, counseled, and educated
about high-risk medications and disease
states. The average HCAHP scores during the intervention period was 78.1%.
257—IMPLEMENTATION
OF
WHOLE BLOOD RAPID THYROID STIMULATING HORMONE
SCREENING BY PHARMACISTS IN
A GROCERY STORE–BASED COMMUNITY PHARMACY SETTING AS
A PRIMARY INDICATOR OF HYPOTHYROIDISM. Green K, Pope N, Lawson K, Wilson J, The University of Texas
at Austin, Soliz R, Montemayor D, Cervantes J, H-E-B, E-mail: npope@utexas.
edu
is to assess the effectiveness of a community pharmacist–delivered thyroid
stimulating hormone (TSH) screening
on detection and treatment of primary
hypothyroidism. Primary hypothyroidism has an estimated prevalence of up to
4.6% in the general population, as stated
by the American Association of Clinical
Endocrinologists (AACE). Undiagnosed
patients are at risk for certain health conditions including cardiovascular disease,
osteoporosis, and infertility. According
to the American Thyroid Association
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APhA2014 ABSTRACTS
and the AACE, measurement of TSH is
the principle screening test for primary
hypothyroidism and is usually the first
test health care providers perform.
Methods: The study will be submitted to the institutional review board for
approval and informed consent will
be obtained from all participants. TSH
screening will be initiated in grocery
store–based community pharmacies
in the Austin, Texas, area using a thirdgeneration supersensitive TSH whole
blood test. Participants will be pharmacy clients ≥18 years of age without a
history of hypothyroidism. Educational
information will be offered to all participants. Participants who test positive
as indicated by a TSH level >5 µIU/mL
will be referred to their general practitioner for a confirmatory test. Participants
will receive a follow-up phone call to
complete a verbal survey regarding the
service. The primary endpoint will be the
effectiveness of the service as measured
by the number of patients with positive
results who followed up with their physician. The secondary endpoint is patient
self-reported assessment of the service.
258—IMPROVING THE COLLABORATIVE CARE PROCESS: DEVELOPING A FRAMEWORK FOR
IMPROVING PHARMACY RESIDENT TRAINING AND CLINICAL
DECISION-MAKING DOCUMENTATION. Garza O, Moon J, Schweiss S,
University of Minnesota, E-mail: [email protected]
Objective: As pharmacists increasingly becoming integrated into the care
process, it is critical that documentation
of pharmacist-provided care is communicated in a consistent, accurate, and
clear manner to ensure the optimization
of drug therapy and avoidance of drugrelated complications. Peer-review processes have recently been used in a variety of practice settings to evaluate and
monitor the performance of pharmacy
practitioners; however, incorporating
and evaluating it within the preparation
and training protocol of future pharmacy
practitioners has not been well described.
The objectives of this project are to develop and implement a framework for im-
e170 JAPhA | 5 4:2 | M AR/AP R 2014
proving drug therapy decision making
and communication among pharmacy
residents through a SOAP note evaluation and peer-review process.
Methods: A committee of resident
pharmacist preceptors and primary
care providers (PCP) will be convened
to develop the evaluation and peerreview process and assessment criteria.
Pharmacy residents will select 3 drug
therapy management notes from their
case record during the 2nd, 3rd, and 4th
quarters of the residency training period
for evaluation. The patient’s PCP will
evaluate the pharmacy resident notes
while an assigned pharmacist outside
the residency training site will evaluate
matching sets of de-identified notes. The
pharmacy residents will meet with the
assigned pharmacists to debrief and discuss the evaluations.
initial review of 10 randomly selected,
de-identified SOAP notes from ambulatory pharmacy residents’ patient documentation records was performed. An
assessment tool was used to evaluate
the accuracy, consistency, and quality of
the selected SOAP notes and scored on a
5-point scale (1 = unacceptable; 2 = poor;
3 = acceptable good; 4 = very good; and
5 = exceptional). The 3 areas requiring
most improvement included a Subjective (S) component (incorporating all
pertinent data/facts); an Assessment
(A) component (interpreting relationships/patterns among data); and a Plan
(P) component (including recommendations for monitoring), with average ratings of 2.8 each.
259—THE INCIDENCE OF HYPOTENSION IN PATIENTS UNDERGOING GENERAL ANESTHESIA.
Hunsicker K, Callejas B, Cook E, Roke
Thomas M, Wilkes University, Saeed I,
Surgical Specialists of Wyoming Valley,
Objective: The purpose of this research is to predict the incidence of hypotension on patients undergoing surgery
with the induction of propofol as general
anesthesia. Studies have shown a significant association of anesthesia dose level
of propofol with hypotension in patients.
This study also may identify predictors
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of hypotension to include, age, sex, medication history, and anesthesia time.
Methods: Student pharmacists obtained blood pressure (BP) readings
from 110 patients during a preoperative visit to the surgical office. Once the
patients completed their surgical procedure, computerized anesthesia records
of these patients were reviewed for total
anesthesia time, blood pressure prior to
surgery, and then at 10-, 20-, and 30-minute intervals following the induction of
propofol. All surgeries were performed
with a length of stay <24 hours. Demographic data, current medications, age,
and sex were retrieved from the surgeon’s electronic health record (EHR) to
determine any additional predictors for
hypotension.
blood pressure records will be analyzed
using paired sample t tests to determine
whether there is a significant difference
in blood pressure at different time intervals following induction of propofol. Regression analysis will be used to predict
hypotension based on age, sex, current
medication, and anesthesia time. The
results are pending completion of the
research. Students became proficient in
taking blood pressure readings and retrieving data from EHRs.
260—THE INCIDENCE OF POSTOPERATIVE COGNITIVE DYSFUNCTION IN THE ELDERLY POPULATION UNDERGOING SHORT-STAY
SURGERY. Overfield K, Bellanco S,
Maheady S, Daubert E, Elczyna S, Roke
Thomas M, Wilkes University, E-mail:
[email protected]
is to determine if there is a significant
relationship between cognitive function
and the administration of general anesthesia to individuals >70 years of age
presenting for short-stay surgery. Patients will be evaluated prior to surgery,
at 1 week postoperatively, and 6 weeks
postoperatively.
Methods: The intervention group
consists of 104 surgical patients >70 years
of age undergoing general anesthesia at
a “same-day outpatient surgical center”
with postoperative intervention <23
hours. The control group includes 102
APhA2014 ABSTRACTS
individuals >70 years of age undergoing
surgery under local anesthesia without
general anesthesia at a local short-stay
surgical office. Cognitive function was
evaluated prior to the introduction of the
anesthesia on the day of surgery, 1 week
after surgery, and 6 weeks after surgery.
Cognitive function was assessed using
the Telephone Interview for Cognitive
Status (TICS). The quantitative score on
the TICS test will be interpreted qualitatively.
study is currently ongoing and the results are being evaluated as received.
Paired t tests will be used to determine
whether there is any significant difference in cognitive function prior to and
1 week after surgery and prior to and 6
weeks after surgery. To date, there is no
significant difference (P>0.05) in cognitive function at 1 or 6 weeks after surgery in the control group. Postoperative
cognitive dysfunction (POCD) is defined
as a change in the results of neuropsychological tests administered before and
after anesthesia and surgery. POCD has
the potential to affect outcomes in the
elderly up to 5 years postoperatively.
POCD presents as a financial and personal challenge for elderly adults because this can result in problems with
commuting, shopping, meal preparation, managing finances, and medication
management. Medication management
postoperatively for these patients can be
challenging for pharmacists.
261—INITIATION OF PHARMACEUTICAL SERVICES FOR THE
MANAGEMENT OF ASTHMA AND
CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A COMMUNITY
PHARMACY. Bhatt V, Masilamani S,
University of Houston College of Pharmacy, Hardin-Oliver C, Walgreens, Email: [email protected]
is to implement and assess the impact of
pharmaceutical services in the management of asthma and chronic obstructive
pulmonary disease (COPD). These services are provided by pharmacists in a
retail pharmacy in Cleveland, Texas. In
2005, among adults aged ≥18 years, there
were 15,424 hospitalizations for asthma
and 26,718 hospitalizations for COPD in
Texas. Liberty County, which includes
the city of Cleveland, was among the top
10 counties for COPD admission rates in
2005.
approval. This is a unique attempt to
provide pharmaceutical care for patients
with asthma and COPD at a retail pharmacy in collaboration with a federally
qualified health center (FQHC) in this
rural city. All pharmacists at the store
are trained in COPD and asthma management. Patients aged ≥18 years who
are picking up any inhalers or inhalation solutions are counseled on respiratory device use technique and are asked
to fill out a validated Asthma Control
Test (ACT) or COPD Assessment Test
(CAT) for the condition self-reported by
the patient. Patients with uncontrolled
asthma or COPD, as assessed by the
tests, are offered an initial 30 minute appointment with a pharmacist followed
by a maximum of 4 monthly 15-minute
follow-up sessions as needed based on
their control. Additionally, patients from
the FQHC are referred to the individual
sessions. For FQHC patients, initial assessment of control and counseling on
device use technique is done at the first
session. After 6 months, anticipated
outcomes include decrease in number
of emergency department visits and/or
hospitalizations based on local hospital
data, improvement in symptom control
based on validated questionnaires, and
reduced rescue inhaler use and improvement in adherence to controller medication based on fill history.
262—NEW PHARMACIST PRACTITIONER READINESS TO PROVIDE
PATIENT CARE SERVICES IN A
COMMUNITY CHAIN PHARMACY
SETTING. Ossman K, McGrath S, Bacci
J, McCartney E, McGivney M, University of Pittsburgh School of Pharmacy,
study are to: (1) assess perceived readiness of new pharmacist practitioners
to provide direct patient care services;
(2) identify necessary competency and
j apha.org
skill gaps in the transition process from
student pharmacist to new pharmacist
practitioner; and (3) identify methods
for developing new training and assessment tools within a community chain
pharmacy.
Methods: As community pharmacy
practice moves toward increased provision of direct patient care services, it is
important that community chain pharmacies train and hire new pharmacists
who are most capable of providing these
services. This study will utilize a mixedmethod approach to assess new pharmacist practitioner readiness to provide direct patient care services. Surveys will be
distributed to approximately 2,400 new
pharmacist practitioners nationwide,
defined as pharmacists with 1 to 3 years
of practice experience since graduation.
Survey questions will be derived from
the Center for the Advancement of Pharmaceutical Education’s 2013 Educational
Outcomes and the National Association
of Chain Drug Stores’ 2012 Entry-Level
Competencies Needed for Community
Pharmacy Practice. Questions will relate
to pharmacist readiness in 5 domains:
pharmacist-delivered patient care, public health, communication, management,
and leadership. Survey results will be
analyzed using descriptive statistics. A
focus group will then be conducted to interpret any identified gaps in patient care
skills or competencies and identify methods to further develop training for new
practitioners. The focus group transcript
will be analyzed using the principles of
grounded theory.
Results: Research in progress. Results of this study will assist in understanding new pharmacist practitioner
readiness to provide necessary patient
care services in a rapidly changing health
care system. Perceived gaps in patient
care skills, knowledge, or experience
by new practitioners can be utilized for
community pharmacies to develop training programs for hiring new practitioners.
263—OPTIMIZING A MEDICATION USE PROCESS TO IMPROVE
SAFETY FOR A SPECIAL-NEEDS
PATIENT POPULATION. Cotugno S,
Saunders C, University of Pittsburgh, EMA R /APR 2014 | 54:2 |
JAPhA e171
APhA2014 ABSTRACTS
mail: [email protected]
Objective: This study aims to identify problems and create interventions to
improve medication safety for children
and adults with disabilities or chronic illness in a non–health care setting.
Methods: The non–health care setting, a camp, is a nonprofit organization providing fully accessible facilities
to children and adults with disabilities
or chronic illness. The camp provides
5-night summer programs and 2-night
weekend programs housing 48 campers. Two student pharmacists were requested by the camp for an advisory/
observational role twice weekly over 12
weeks. The role included making observations at medication check-in, dispensing, storage, and administration in
addition to studying the camp’s initial
operational design. The identification of
errors and potential medication use errors were made and discussed with the
Board of the Directors. Small changes
were implemented immediately while
substantial policy, procedural, and education/training changes were submitted
for approval.
Results: Problems identified included administering medications to the
incorrect patient, inappropriate administration time, medications incorrectly
measured, inadequate monitoring parameters, and lack of an organizational
design. A plan was implemented to correct these deficiencies, which included
instituting a photographic process at
check-in to ensure patient identification,
creating written operational procedures
for the medication management process,
improving work processes for safety and
efficiency, and preparing a training manual for non–medical staff on medication
management and administration.
Conclusion: It is anticipated that
these efforts will result in a reduction in
medication errors. The final assessment
cannot be adequately determined until
the end of the next summer program by
evaluating the reported number of medication errors from before and after the
interventions. Both pharmacists and student pharmacists can play an important
role in assuring for safe medication use,
adequate health care training, and proper dispensing techniques in non–health
e172 JAPhA | 5 4:2 | M AR/AP R 2014
care settings such as schools, camps, and
day-care facilities, in addition to providing safety measures for specialized
populations such as elderly adults and
disabled persons.
264—ORIENTATION TO PHARMACY SERVICES: AN EDUCATIONAL
PROGRAM FOR RESETTLED REFUGEES. Kim H, Kilbane G, The Ohio State
University, Michaels B, Kroger Corporation, Rodis J, The Ohio State University,
Objective: This project aims to provide an educational presentation about
pharmacy services for resettled refugees
to the United States.
Methods: A grocery store chain
pharmacy located in a diverse section of
Columbus, Ohio serves many customers unaccustomed to health care in the
United States. The surrounding neighborhood is a refugee resettlement area
accepting 50 to 100 refugees to the United
States every month. This newly resettled
refugee population has limited understanding of U.S. pharmacy systems and
services. To help overcome cultural barriers and better serve this population, the
pharmacy implemented a new program
called Orientation to Pharmacy Services.
Each month, advanced practice student
pharmacists conduct a 2-hour educational session for newly resettled refugees that provides information on: differences between over-the-counter and
prescription medications, how to obtain
a prescription, why medications have
refills, and how to order refills. Resettled
refugees are shown how to use the pharmacy and read a prescription label. This
presentation is verbally interpreted into
the refugees’ home languages and supplemented by visual aids. A translated
handout is also provided to participants.
This program incorporates an informal
question and answer session to address
misunderstandings and concerns about
pharmacy services.
Results: Research in progress. Pilot
sessions held in July and September of
2013 educated 24 patients from 2 different language groups, Nepali and Swahili. Preliminary results will report logistics of the sessions as well as the number
of sessions held and the number of paja p h a .org
tients reached.
Conclusion: The study describes a
method for increasing newly resettled
refugees’ understanding of U.S. pharmacies and available services. Enhanced
understanding is expected to improve
access to medications, medication management, and pharmacist care.
265—PATIENT-CENTERED MEDICAL HOME: IMPLEMENTATION OF
A PHARMACY COLLABORATIVE
CARE MODEL. Nagy I, Meijer Inc., Email: [email protected]
Objective: The aims of this project
are to: (1) implement a pharmacy collaborative care model with the intent to
improve clinical outcomes and patient
and physician satisfaction of care; and
(2) document the impact of community
pharmacy–based medication therapy
management in patients with chronic
disease states or in patients who are taking multiple medications being provided
care through the patient-centered medical home (PCMH) model.
Methods: Patients are identified
following a routine physician visit at a
specified medical group and have their
prescriptions filled through 2 locations of
a regional grocery store chain pharmacy
and are participants in a cohort of Priority Health Medicare Part D program. The
medical group–based pharmacist meets
with patients during their routine physician visit at which time the patients are
asked to participate in a comprehensive
medication review (CMR) with a community pharmacist at 1 of the 2 identified
pharmacy locations. Patient information is communicated to the community
pharmacist via secure and protected email at which time the pharmacist schedules a CMR with the patient to assess
regimen efficacy, safety, cost efficacy,
and patient adherence. Details from
the CMR are communicated back to the
physician group–based pharmacist to
be forwarded to the patient’s physician.
Any changes in the patient’s treatment
regimen are communicated back to the
community pharmacist for follow-up
with the patient. Both patients and physicians participate in satisfaction surveys
at baseline and at the end of the study
period. Medication adherence data are
APhA2014 ABSTRACTS
obtained at baseline, 6 months, and at the
conclusion of research utilizing medication possession ratios calculated from
patient refill data with a goal to determine whether community pharmacist
intervention in a PCMH model impacts
medication adherence or patient/prescriber satisfaction.
Results: Research in progress. Anticipated results are improved rates of
satisfaction and medication adherence as
well as improved clinical outcomes.
266—PATIENTS’
PERCEPTIONS
OF A COMMUNITY PHARMACY–
BASED FRACTIONAL EXHALED
NITRIC OXIDE SCREENING PROGRAM AND ITS IMPACT ON INHALED CORTICOSTEROID ADHERENCE RATES. Shah P, Hussein
S, Chicago State University College of
Pharmacy, Shafer E, Kshatriya S, Dominick’s Pharmacy, Mukherjee K, Chicago
study are to: (1) assess patients’ perceptions of testing fractional exhaled nitric
oxide (FeNO) in a community pharmacy
setting; and (2) assess patients’ adherence to prescribed inhaled corticosteroids (ICS) based on participation in the
program.
Methods: This survey-based, prospective, single-site (i.e., grocery store
pharmacy setting) study involves the
implementation of FeNO testing, which
measures inflammation in the lungs. Inclusion criteria: patients ≥18 years of age,
experiencing any respiratory symptoms
(e.g., shortness of breath, allergy symptoms), and/or have a diagnosis of asthma or chronic obstructive pulmonary
disease (COPD). Exclusion criteria: patients with allergy or intolerance to ICS
or short-acting beta-agonists or unable
to commit to follow-up appointments.
Patients will be recruited by the pharmacy staff via advertisement of the program throughout the store. At the time
of the initial screening appointment,
patients will complete a pre-survey,
which will gather demographic data,
baseline knowledge about asthma and
COPD management, and baseline status
of patients’ medication adherence. The
service will consist of an educational session with the pharmacist, where the relevance of FeNO testing will be covered,
followed by the patient performing the
FeNO test. The patient will be referred
to a participating physician if evaluation,
treatment, and/or change in treatment is
needed based on test results. The patient
will be scheduled for a follow-up FeNO
testing appointment 14 days from the
day the prescribed medication is picked
up. After the follow-up appointment, patients will complete a post-survey, similar to the pre-survey. Descriptive analysis will be utilized to analyze the data.
Conclusion: The program aims to introduce an innovative screening device
to patients in a community pharmacy
setting to help improve medication adherence and manage patients’ asthma,
COPD, or allergy symptoms.
267—PHARMACIST-DELIVERED
MEDICARE ANNUAL WELLNESS
VISITS IN A PRIMARY CARE OFFICE. Thomas M, VHQC, E-mail: [email protected]
is to describe the development and implementation of a pharmacist-delivered
Medicare Annual Wellness Visit in a
physician-owned private family practice
office.
Methods: A pharmacist working in
a private family practice office describes
the conception, development, planning,
and implementation of Medicare Annual
Wellness Visits for the practice.
Results: From September 2012 to
February 2013, 174 patients participated
in the pharmacist-delivered Medicare
Annual Wellness Visits. The practice
income from wellness visits during this
time frame was $27,880.98.
Conclusion: Pharmacist-delivered
Medicare Annual Wellness Visits are
financially viable and allow for pharmacist participation on the primary care
team.
268—PHARMACIST’S ROLE IN ENGAGING PATIENTS IN A SMOKING
CESSATION PROGRAM USING
HEALTH INFORMATION TECHNOLOGY WITHIN A PATIENT-CEN-
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TERED MEDICAL HOME. Singrey A,
Mehta B, Casper K, Shaffer W, The Ohio
Wexler R, The Ohio State University
Wexner Medical Center, Arradaza N,
The Ohio State University, E-mail: [email protected]
is to: (1) evaluate patient engagement in
a smoking cessation program through
active messaging with a pharmacist using an online patient portal; and (2) assess patient satisfaction of a smoking cessation program using health information
technology (HIT).
Methods: The National Committee
for Quality Assurance (NCQA) recognizes patient-centered medical homes
(PCMH) that meet specific standards
including identifying and managing
patient populations through utilization
of HIT. Pharmacists can help PCMHs
meet those standards by engaging patients who are ready to quit smoking in a
smoking cessation intervention through
an online, secure patient portal. A list of
documented smokers is generated using
the electronic medical record, and targeted patients are telephoned to identify
those reporting readiness to quit within
30 days. Patients schedule a face-to-face
visit with a pharmacist to begin a 3-step
smoking cessation program. At initial
visit, patients enroll in the patient portal and complete Step 1 of the program
including identifying reasons and motivation for quitting. One week later, they
utilize the patient portal messaging system to complete Step 2, which examines
behavioral techniques to curb temptations. Contact is made with the patient
on quit date and then 1 week later to
provide tips for staying smoke-free. One
month after Step 1 completion, patients
take a satisfaction survey to evaluate
both their interaction with the pharmacist and the smoking cessation program.
Two months after quit date, patients are
contacted to determine smoking status.
A pharmacist-directed patient portal
smoking cessation program at a PCMH
may be an effective way to identify and
manage the smoker population using
HIT, assisting PCMHs in meeting NCQA standards.
Results: Research in progress. PreMA R /APR 2014 | 54:2 |
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APhA2014 ABSTRACTS
liminary data presented includes patient
demographics, percentage of patients actively engaged in scheduled correspondences of smoking cessation program,
percentage of patients who initiate correspondence with pharmacist, quit status 2 months after quit date, and patient
satisfaction.
PERCEPTIONS OF THE ROLE OF COMMUNITY PHARMACISTS IN WEIGHT
MANAGEMENT. Pekny C, Walgreens/Purdue University College of
Pharmacy, Sheehan A, Purdue University College of Pharmacy, Arnett S, Walgreens, Snyder M, Purdue University
College of Pharmacy, E-mail: chelsea.
[email protected]
is to determine pharmacists’ perception
of the role of community pharmacists
in weight management, knowledge of
treatment and guidelines, and comfort
level in discussing weight management
with patients.
Methods: Pharmacists will be contacted using a listserve of all Indiana
pharmacists purchased from the Indiana Board of Pharmacy to participate in
a Qualtrics electronic survey. Pharmacists will be asked about their current
practice setting, and a branched survey
will be used based on response. Community pharmacists will be surveyed
about comfort level discussing weight
management with patients, knowledge
of treatment and guidelines, and the
community pharmacists’ role in providing weight management services.
Pharmacists in non–community settings will be surveyed about comfort
level in recommending that patients
discuss weight management with their
community pharmacist and the need
for community pharmacists to provide
these services. A 5-point Likert–type
scale and yes/no questions will be used
to assess responses, where appropriate.
Participation in the survey will be on a
volunteer basis and participants will be
entered in a drawing to win 1 of 5 $50
gift cards. The survey will be distributed
over 2 months and data will be collected
over 6 months. Data will be analyzed
using appropriate parametric and non-
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parametric tests. The study protocol is
pending institutional review board and
corporate approval; survey distribution
and data collection will begin upon approval. Using results from the survey, a
training program can be developed that
gives community pharmacists the ability to effectively be a part of patients’
weight management. Training can include education on effective interaction
with patients, over-the-counter and prescription medications, diet and exercise
recommendations, and incorporation of
weight management into practice based
on survey results.
270—REDUCING
PREVENTABLE HOSPITAL READMISSIONS
THROUGH A PHARMACIST-LED
CARE TRANSITION INTERVENTION. Clark B, Cohen E, Kwasigroch D,
Singer S, Hou J, Walgreen Co., E-mail:
[email protected]
this research study will be to evaluate a
pharmacist-led care transition program
designed to assist in reducing preventable hospital readmissions. This care
transition program encompasses the
retrieval of community pharmacy medication histories, the delivery of medications to the bedside at discharge, medication alignment and prescription therapy
planning, and follow-up reminder calls
to encourage medication adherence and
to monitor health outcomes.
Methods: This will be a retrospective case comparison cohort study using
propensity score matching. For comparison purposes, patients enrolled in this
pharmacist-led care transition program
will be matched with similar patients in
terms of age, sex, disease state, illness
severity, comorbidities, and other pertinent predictors of hospital readmission.
The first 6 to 9 months of the program’s
implementation will be evaluated in 4
hospitals, and the primary outcome variable will be 30-day hospital readmission
rates.
Results: Research in progress. After
only 6 months since the program’s implementation, preliminary results show
that patients had a 37% lower unadjusted 30-day readmission rate, relative
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to patients who were eligible for but not
enrolled in the program. The estimated
number of averted readmissions was
21.1, which translates into a total savings
of $202,896 or $530 per engaged patient.
As the data continue to accumulate, a
formal research study is planned to verify these preliminary findings.
271—UNDERSTANDING EMPLOYEE PERCEPTIONS OF A PHARMACIST-PROVIDED SMOKING CESSATION SERVICE IN THE COMMUNITY PHARMACY SETTING.
Caracciolo C, Thomson M, Acme Sav-on
Pharmacy, Patel N, Temple University
School of Pharmacy, Melissen P, Acme
Sav-on Pharmacy, E-mail: [email protected]
study is to obtain the perceptions of employees of 2 regional grocery store chains
on a pharmacist-provided smoking cessation service in the community pharmacy setting.
Methods: This multi-site prospective study includes adults who are >18
years of age, identify themselves as active cigarette smokers or having quit
within the past 6 months, and are current
employees of 2 regional grocery store
chains. Eligible associates will be recruited during employee health screenings
and in participating regional grocery
store chains. Participants meeting inclusion criteria will receive a survey with
questions pertaining to demographics,
smoking status, past quit attempts, and
their perceptions of a pharmacist-provided smoking cessation service. Descriptive statistics will be used to analyze
and compare results.
Results: Research in progress. Recent health care reform has led to a greater focus on the reduction of tobacco use.
The increasing adoption of workplace
smoking bans and the growing number
of insurers offering discounted medical
premiums for nonsmokers has created
a need to identify the impact that pharmacists can have in the smoking cessation process. The results of this study will
identify how the needs of tobacco users,
in regard to smoking cessation, can be
used to identify the desired structure
and support required to successfully quit
APhA2014 ABSTRACTS
smoking. This research also will determine the willingness of patients to participate in a pharmacist-provided smoking cessation service in the community
setting. Identifying these critical factors
will help support recognition of pharmacists as providers of smoking cessation
services.
272—WHAT EFFECTS DO MEANINGFUL USE MEASURES HAVE
ON TOBACCO CESSATION IN A
COMMUNITY HEALTH CENTER?.
Youngblood A, Ramirez S, Oregon State
University, Davis J, Fred Meyer Pharmacy, E-mail: jennifer.davis@stores.
fredmeyer.com
was to describe how often meaningful
use measures around tobacco use are
being asked in a community health center and whether asking these questions
leads to tobacco cessation counseling.
Secondarily, this study described the
types of tobacco cessation education that
were being provided to patients assessed
as tobacco users. “Meaningful use” is the
set of standards defined by the Centers of
Medicare and Medicaid Services (CMS)
Incentives Program that regulates the
use of electronic health records (EHRs).
The goal of meaningful use is to promote
the adoption of EHRs across the United
States to improve health care. One of the
measures set forth is the assessment of
tobacco use at each patient encounter.
The results from this study will be used
to design a targeted intervention program for tobacco cessation at this clinic.
Methods: The primary outcome of
this study was the percentage of visits
that were applicable to asking a patient
3 questions regarding tobacco use, readiness to quit, and willingness to receive
additional patient education. The secondary outcomes of this study were to
determine the percentage of visits that
received patient education if the patient
reported being ready to quit and the
type of education provided. Retrospective chart reviews were conducted on
EHRs collected for over 1,000 patient
visits from June 1, 2012 through May 30,
2013. Records were obtained for patients
>18 years of age. Patients’ responses to
the tobacco use questions were docu-
mented. From this dichotomous data,
the percentage of eligible visits for cessation counseling were determined and
the types of patient education provided
were documented.
Personalized Medicine/Pharmacogenomics
273—FROM GENES TO RNA EXPRESSION PROFILES: A SHIFT IN
UNDERSTANDING BREAST CANCER DEVELOPMENT AND ITS RESPONSE TO CHEMOTHERAPY. Yao
D, Ji S, Rutgers University, E-mail: sji@
rci.rutgers.edu
Objective: Traditional cancer research has focused on specific oncogenes
as the determinants of carcinogenesis.
Using the complementarity principle
prevalent in other fields, this study proposes that there is another factor contributing to cancer formation. One such
factor is mRNA “copy number,” the
transcript level of specific genes determined by the balance between transcription and degradation rates. This study
aims to explore the correlation between
mRNA copy numbers and tumor development and treatment in patients with
breast cancer.
Methods: Microarray data were
analyzed for 4,740 genes from 20 human
patients with breast cancer patients [Perou CM et al. Nature. 2000;406:747–52].
mRNA levels were measured in normal
breast tissue culture and before and after doxorubicin treatment for each patient. Genes were classified as exhibiting
harmful or beneficial RNA expression
profiles based on mRNA changes: harmful profiles had tumor mRNA changes
exacerbated by doxorubicin treatment,
and beneficial profiles had tumor mRNA
changes reversed by doxorubicin treatment.
Results: No gene exhibited a common beneficial or harmful RNA profile in
all patients. The majority of genes shared
common profiles in only 1–5 patients,
and many genes exhibited conflicting
profiles in different patients. Poisson
distributions were obtained describing
the frequency of genes exhibiting either
beneficial or harmful profiles, with re-
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spective modes of 4 and 2 patients. The
beneficial:harmful mode ratio (2) can be
a quantitative measure of the efficacy of
doxorubicin in treating breast cancer.
Conclusion: The lack of genes exhibiting a common profile suggests that
viewing individual oncogenes as the sole
determinants of carcinogenesis is too
simplistic. These results from analyzing
this gene pool suggest that sets encompassing perhaps hundreds of genes are
involved in carcinogenesis. These sets
may include genes that encode proteins
for regulating mRNA transcription and
degradation. Understanding sequence–
copy number complementarity may
enable development of ways to better
combat cancer and further develop personalized medicine.
274—INFLUENCE OF GLUTATHIONE S-TRANSFERASE POLYMORPHISMS ON CISPLATIN KINETIC
EXCRETION IN PATIENTS WITH
HEAD AND NECK CANCER. Pincinato E, Mackenzie Presbyterian University, Moriel P, Lopes-Aguiar L, Costa E,
Nogueira G, Lima T, Lima C, Faculty
of Medical Sciences, Unicamp, E-mail:
[email protected]
Objective: The aim of this work was
to evaluate the urinary cisplatin (CDDP)
kinetic excretion associated with glutathione S-transferase (GST) polymorphisms in patients with squamous cell
carcinoma of head and neck (SCCHN).
Methods: At the University of
Campinas, 105 patients with SCCHN
received 35 sessions of radiotherapy (2
Gy per session) plus intravenous CDDP
(75–100 mg/m2 on days D1, D22 and
D43). Blood samples were obtained to
DNA extraction and urine was obtained
from 0 to 12, 12 to 24, and 24 to 48 hours
after CDDP administration. Urinary
CDDP was detected with HPLC-UV
and GSTs genotypes were evaluated using multiplex polymerase chain reaction
(PCR) and PCR and enzymatic digestion
respectively.
Results: GSTM1 and GSTT1 null
genotypes were identified in 56.2% and
11.4% of patients, respectively; 47.6%,
44.8% and 7.6% of patients presented
GSTP1 IleIle, IleVal and ValVal genotypes, respectively. Nearly 84.4% of
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JAPhA e175
APhA2014 ABSTRACTS
CDDP was eliminated in urine of a 0- to
12-hour period. Patients with GSTT1
null genotype eliminated less CDDP in
urine than those with the genes (68.67
± 49.94 vs. 46.29 ± 39.37 µg CDDP/mg
creatinine). Patients with GSTP1 variant
Val/Val genotype eliminated less CDDP
in urine than those with Ile/Val and
Val/Val genotypes (41.35 ± 30.20; 63.88 ±
49.53; 67.11 ± 50.94 µg CDDP/mg creatinine, respectively).
Conclusion: Urinary CDDP detection by HPLC-UV is a powerful tool to
analyze kinetics excretion of the drug.
GSTT1 and GSTP1 Ile105Val polymorphisms alter CDDP excretion in urine.
Thus, patients SCCHN patients with
inherited distinct abilities for CDDP
metabolism associated with these genes
may exhibit distinct responses and toxicities to conventional treatment.
Pharmacist Behaviors and Attitudes
275—ASSESSING PHARMACISTS’
ATTITUDES TOWARD EXPANSION OF CARE IN PHARMACY
PRACTICE. Aldrich S, Sullivan D, Ohio
Northern University, E-mail: s-aldrich@
onu.edu
Objective: The profession of pharmacy is constantly changing. Where
will we be 20 years from now? The opportunities for expansion of care in pharmacy practice are vast including limited
prescriptive authority, managing acute
and chronic disease states, and even interpreting pharmacogenomic data. This
study assessed pharmacists’ attitudes
toward potential expansion of care areas and their perceived competency and
training in each area.
Methods: Five hundred pharmacists
from Ohio were randomly selected for
inclusion in the study; 174 completed
the survey (35% response). A 54-question, self-administered, mailed questionnaire was used to collect data using a
Likert-type scale (1 = strongly disagree;
7 = strongly agree). Several topics were
assessed including the pharmacists’ attitudes toward obtaining prescriptive
authority; the ability to monitor and
manage chronic diseases and acute infections, such as strep throat, urinary tract
e176 JAPhA | 5 4:2 | M AR/AP R 2014
infections, and ear infections; the ability
to order and interpret lab tests; and the
role of medication therapy management
(MTM) programs in their practice. Demographics included sex, age, degree,
and number of years and area of practice.
Results: Pharmacists moderately
agreed that they should have limited
prescriptive authority (5.68), and moderately agreed that it should be limited to
certain drugs (6.06). Pharmacists slightly
to moderately agreed that they should be
able to authorize a 1-month additional
refill for a non-controlled prescription
drug that the patient has taken for over
year (5.51) and slightly disagreed they
needed extensive training to do so (3.01).
Participants slightly to moderately
agreed that they should be able to manage diabetes using blood glucose testing
(5.65), diabetes using A1C testing (5.63),
hypertension using blood pressure
measurements (5.51), and cholesterol
using lipid panels (5.59). With appropriate training, pharmacists moderately
agreed that they would feel comfortable
conducting a Rapid Strep Test (5.81) and
moderately agreed that based on the
results they would feel comfortable prescribing a treatment (5.64). Pharmacists
slightly agreed that they should be able
to order and interpret pharmacogenetic
testing to determine therapeutic appropriateness of drugs (4.79), however they
moderately agreed that they would need
extensive training to do so (5.70). Finally,
pharmacists slightly agreed that MTM
would become more prevalent (5.19)
and beneficial (5.30) if they could adjust
therapy as needed.
Conclusion: Based on the results of
this study, pharmacists are ready to expand their scope of care and the clinical
services they could offer.
MEDICATION MONITORING: EXPERIENCES, ATTITUDES, AND
BARRIERS. Witry M, Doucette W, University of Iowa College of Pharmacy, Email: [email protected]
Objective: Medication monitoring
is an emerging role for community pharmacists and is associated with an increasing focus on quality and outcomes. There
has been little description of the associja p h a .org
ated processes and factors involved with
current monitoring practice. The objective of this study is to describe the attitudes, contextual factors, activities, and
behaviors associated with community
pharmacist medication monitoring in
the dispensing process.
Methods: Twelve, 45-minute, semistructured interviews were conducted in
person or telephonically with community pharmacists from independent, chain,
and grocery pharmacies. Participants
were selected randomly from a state
list or purposefully based on pharmacy
reputation of providing quality cognitive services. Interviews were audiorecorded and transcribed. Transcripts
were coded descriptively and interpretively, beginning with the domains of
the Health Collaboration Model. Pattern
codes were identified iteratively. Representative quotations were identified and
theme summaries were prepared. Check
coding supported the interpretations.
Results: Overall, pharmacists’ medication monitoring was constrained by
busyness, although interviewees were
open to more monitoring interactions.
Some pharmacists perceived patients as
disinterested in medication monitoring,
especially when busy or using the drivethrough pickup. Pharmacists were less
likely to monitor medications viewed
as routine. Rather, they responded to
unique circumstances such as patient
question-asking, prior memory of a patient interaction such as service utilization, discussion of technical issues such
as medication cost, or when handing off
the prescription. Pharmacists felt challenged by nonadherence monitoring because workflows generally do not make
this information easily accessible and
due to the high prevalence.
Conclusion: Pharmacists reported
numerous barriers to medication monitoring in practice including busyness,
workflow issues, information inaccessibility, and patient disinterest. Barriers
need to be addressed if pharmacists are
to take on a greater medication monitoring role in the interest of improving quality.
QUESTION ASKING AT THE TIME
APhA2014 ABSTRACTS
OF REFILL: RESULTS OF A FACTORIAL SURVEY. Witry M, Doucette W,
University of Iowa, E-mail: matthew.
[email protected]
Objective: Inadequate medication
monitoring contributes to more medication-related problems than errors in
prescribing, yet monitoring has received
less attention in practice and research.
Community pharmacists are well positioned to engage in medication monitoring. The objective of this study was
to identify significant contextual and
pharmacist-level factors associated with
community pharmacist self-reported
likelihood to ask medication monitoring
questions at the time of refill.
Methods: Surveys were mailed to
599 community pharmacists using a
Dillman approach. Surveys included demographics, 6-point Likert-type attitudinal items addressing monitoring roles
(internal) and environment monitoring
perceptions (external), and 5 unique refill vignettes randomly populated with
values for 8 contextual variables based
on the Health Collaboration Model.
Respondents assigned their likelihood
of asking nonadherence, safety, and effectiveness questions for each vignette.
Hierarchical linear modeling produced
regression coefficients for pharmacistlevel and vignette-level variables.
Results: There were 254 (43%)
returned, usable surveys. Overall, respondents had a moderately positive
internal medication monitoring attitude
(4.62) and an external monitoring attitude slightly conducive to monitoring
(3.87), although with appreciable variation. For nonadherence, female patients
were more likely to be questioned. Being
short-staffed and the prescription previously being filled more times did not
decrease likelihood, unlike with side effect and effectiveness questions. Side effect and effectiveness questioning may
be seen as more discretionary than nonadherence questioning. Other persons
waiting decreased likelihood of asking
all 3 questions. Overall, metoprolol and
fluoxetine were less question worthy
than warfarin and hydrocodone.
Conclusion: Pharmacists reported
variation in question asking likelihood
based on medication, patient, and envi-
ronmental characteristics. Pharmacist
medication monitoring attitudes contributed more to explaining pharmacist
medication monitoring attitudes than
setting, suggesting there are pharmacists
oriented to monitoring in multiple settings. Days late was a cue to asking for
all 3 question types. Pharmacies should
ensure late refill information is reaching
pharmacists if increases in medication
monitoring are desired.
278—EFFECTIVENESS OF AN EDUCATIONAL INTERVENTION ON
THE CARING BEHAVIORS AND
REFERRAL ACTIVITIES OF COMMUNITY PHARMACISTS. O’Neal
K, Murray K, University of Oklahoma College of Pharmacy, Skomo M,
Duquesne University Mylan School of
Pharmacy, Carter S, University of Oklahoma College of Pharmacy, McConaha
J, Duquesne University Mylan School
of Pharmacy, E-mail: katherine-oneal@
ouhsc.edu
Objective: The objectives of the
study were to: (1) identify previously
diagnosed migraineurs’ perceptions of
care by pharmacists who have undergone specialty training in migraine versus those who have not had specialty
training in migraine; (2) identify perceptions of patients with previously undiagnosed recurrent headache regarding
pharmacist effectiveness and thoroughness, after specialty training, to identify a
potential migraine diagnosis and referral
for advanced care; and (3) identify pharmacists’ perceptions regarding (a) their
interactions with migraine and recurring
headache patients and (b) the migraine
training program and caring for patients
with recurrent headache.
Methods: This study was a 2-group,
multi-site, quasi-experimental, cohort
design using community pharmacies
from the Tulsa, Oklahoma, and Pittsburgh, Pennsylvania, greater metropolitan areas. Pharmacists from intervention
pharmacies received specialty training
on migraine. Approximately 1 month after the training, control and intervention
pharmacists were surveyed regarding
(a) their interactions with migraine and
recurring headache patients and (b) their
perceptions about the migraine training
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program and caring for patients with recurrent headache. In addition, patients
from both pharmacies were surveyed to
measure headache-related disability using the Migraine Disability Assessment
(MIDAS) and assess pharmacists’ delivery of care as derived from the Pharmacists’ Care of Migraineurs Scale.
Results: Sixteen pharmacists and 60
patients were recruited. There was no
difference in patient perception of pharmacists’ care or in patient self-perception
between migraineurs and patients with
recurrent headache. Ninety-two percent
of pharmacists agreed that the program
could be transferred to an Internet-based
educational program. The 14-item patient survey demonstrated good internal
consistency reliability with each question having a Cronbach alpha ≥0.80.
Conclusion: There are few studies
evaluating the role and potential impact
community pharmacists can have on patients with migraines or recurrent headaches. While no difference was found between the groups, the internal reliability
of the survey questions and the need to
address needs of migraineurs warrants a
larger-scale study.
279—EFFECTS OF AGGRESSIVE
PATIENT BEHAVIOR ON PHARMACIST JOB STRESS AND JOB SATISFACTION. Liu N, Kings Pharmacy,
Lonie J, Arnold and Marie Schwartz
College of Pharmacy and Health Sciences Long Island University, E-mail:
[email protected]
Objective: The aim of the study was
to assess the effect of aggressive patient
behavior on pharmacist job stress, job
satisfaction, and intention to leave the
profession.
Methods: A purposeful sample of 40
actively practicing community pharmacists from the New York metropolitan area was selected to complete a retrospective survey in which participants were
asked to recall and reflect on incidents
with aggressive patients. Currently practicing community pharmacists working
a minimum of 20 hours per week at an
independent, chain, mass merchant, or
food store pharmacy were selected for
participation. Depending on the preference of the participant, surveys were
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APhA2014 ABSTRACTS
distributed via mail or e-mail. Data were
analyzed quantitatively using SPSS software.
Results: Research in progress; no
results to report at this time. Pharmacist job stress and dissatisfaction due to
consistent encounters with aggressive
patients may lead to increased job turnover, resulting in compromised patient
care. Excessive job turnover can affect
the number of experienced well-trained
pharmacists in community settings. If
the results of this study demonstrate that
pharmacist job stress and job satisfaction
are negatively affected by patient aggression, implementing strategies to assist
pharmacists to better deal with these
encounters may be needed. Creation of
educational programs focused on conflict management may be beneficial for
pharmacists to overcome the impact of
patient aggression on job stress and dissatisfaction. These educational programs
may include techniques to recognize and
mitigate potentially aggressive encounters before they arise and techniques to
overcome communication barriers during incidents of aggression.
280—EVALUATION OF AN EDUCATIONAL INTERVENTION ON
COMMUNITY
PHARMACISTS’
CARE OF RECURRENT HEADACHE
SUFFERERS. Murray K, University of
Oklahoma College of Pharmacy, Skomo
M, Duquesne University Mylan School
of Pharmacy, Carter S, University of
Oklahoma College of Pharmacy, E-mail:
[email protected]
Objective: The objectives of the
study were to: (1) compare pharmacists’
self-assessed knowledge of migraine
before and after an educational intervention; (2) compare pharmacists’ selfreported care behaviors following an
educational intervention with a control
group of pharmacists; and (3) identify
interactions between the educational intervention and individual independent
variables.
Methods: The study employed a
quasi-experimental, parallel design.
Pharmacists were recruited from community pharmacies in a regional chain
in northeastern Oklahoma. A questionnaire containing a survey assessing self-
e178 JAPhA | 5 4:2 | M AR/AP R 2014
reported care behaviors was administered to the intervention group of pharmacists at baseline just prior to their participation in a 2-hour educational course
on migraines. One month later, the
intervention pharmacists were asked to
complete the same questionnaire. Pharmacists in the control group completed
their only questionnaire at the same time
the intervention pharmacists completed
their follow-up questionnaire. The selfreported care behaviors assessed in the
survey were: (1) perceived difficulty in
providing care to patients with recurrent
headaches; (2) perceived self-efficacy
or level of confidence in providing care
to patients with recurring headaches;
(3) employer culture; (4) self-assessed
knowledge of migraine; (5) actual care
provided to patients with recurring
headaches; and (6) ability to maintain
knowledge of migraine. Descriptive and
appropriate inferential statistical analyses were performed using SAS v9.3.
Results: The intervention group
was composed of 24 pharmacists and
there were 25 pharmacists in the control
group. Pharmacists’ self-assessed knowledge mean scores were significantly
different pre- and post-intervention (P
<0.0001). Self-assessed knowledge was
higher in the intervention group postquestionnaire scores compared with the
control group (P = 0.004). Intervention
group pharmacists were more confident
in their ability to maintain knowledge of
migraine (P = 0.04). No difference was
seen regarding difficulty in providing
care for a migraineur (P = 0.16) or in how
the pharmacists perceived employer culture (P = 0.79).
Conclusion: Participating in an educational program on migraine improved
pharmacists’ knowledge of migraine
and their confidence providing care to
migraineurs.
281—IDENTIFYING COMMUNITY
PHARMACISTS’ READINESS TO
PARTICIPATE IN TRANSITIONS OF
CARE. Gibson N, Kebodeaux C, St. Louis College of Pharmacy, Smith D, Holtgrave K, Walgreens, Gattas N, St. Louis
College of Pharmacy, E-mail: ngibson@
stlcop.edu
ja p h a .org
is to determine the readiness of community pharmacists to participate in transitions of care and identify additional
training perceived to be beneficial.
Methods: Medication discrepancies,
adverse effects, nonadherence, and lack
of patient understanding of treatment
commonly occur in the post-discharge
period. These undesirable outcomes often contribute to hospital readmission
that could be prevented with improved
care coordination. Community pharmacists are in a unique position to widely
impact patient health outcomes and decrease hospital readmission rates. Currently, community pharmacists do not
formally participate in transitions of care
and there is no research regarding their
readiness to participate. A questionnaire
will be used to identify the community
pharmacists’ willingness, attitudes, and
barriers to participation in transitions
of care. The questionnaire will be validated by experts and piloted on select
community pharmacists prior to implementation. The anonymous paper questionnaire will be distributed to approximately 250 community pharmacists.
Descriptive statistics, correlations, and
chi-square tests will be used to analyze
demographics and determine differences in final results.
study will provide useful information regarding community pharmacists’ readiness to participate in transitions of care
and help to identity the characteristics of
community pharmacists correlated with
a strong desire to participate in transitions of care. The questionnaire will be
beneficial in identifying potential barriers and determining additional training
necessary for community pharmacists to
feel confident in their ability to participate in transitions of care.
282—IMPROVING THE SELF-CONFIDENCE OF STUDENT PHARMACISTS TO SIMPLIFY COMPLICATED MEDICATION REGIMENS.
Ghura S, Chewning B, University of Wisconsin–Madison, E-mail: sonalghura@
gmail.com
Objective: Student pharmacists in
community settings are ideally situated
to help patients simplify complicated
APhA2014 ABSTRACTS
regimens, however students’ self-efficacy is not known. This study aims to: (1)
test the impact of a student assignment
using a structured grid to optimize patients’ regimen dose timing on a student
pharmacist’s self-efficacy and the intention to do this activity as a practicing
pharmacist; and (2) identify medical
conditions and drugs targeted most frequently when altering patients’ regimen
dose timing.
Methods: A pre-post design is being
used to evaluate the impact of a community pharmacy clerkship assignment
for 132 fourth-year students in the doctor of pharmacy program. The assignment requires each student to optimize
the daily timing of medication doses for
2 patients with ≥5 prescription medications. A structured grid will be used to
record medication timing before and
after the student pharmacists’ consult.
The hypothesis is that the assignment
will contribute to increased self-efficacy
for student pharmacists and increased
intention to help patients simplify complicated regimens. To explore the assignment impact, a self-reflection questionnaire measuring self-efficacy and intention is being used. Scales were adapted
from reliable scales and were informed
by social cognitive theory. Self-efficacy
is measured by a 7-item 7-point scale
and intention is measured by a 3-item
6-point scale. A frequency table will be
constructed to identify the most common disease areas and drug classes
where pharmacists modified the dosing
schedule. Self-report of the measures in
the questionnaire and a lack of random
assignment are limitations to this study.
Results: Research in progress. Thus
far, data on 16 student pharmacists and
25 patients have been collected. Only 2
patients reported ever having a health
care provider (i.e., pharmacist and physician) help them simplify and optimize
their medication dose timing. Increased
self-efficacy of pharmacists may promote simplifying medical regimens for
patients, thereby reducing a practical
barrier to adherence.
283—NEW JERSEY PRESCRIPTION
MONITORING PROGRAM: PHARMACISTS’ PERCEPTIONS AND
COMMENTARY. Drimalla B, Wagner
A, Volino L, Toscani M, Feudo D, Yue R,
Rutgers University, E-mail: [email protected]
study are to evaluate New Jersey outpatient pharmacists’ knowledge and
perceptions of the New Jersey Prescription Monitoring Program (NJPMP) and
capture commentary from pharmacists.
New Jersey is 1 of 44 states with an operational prescription monitoring program. The NJPMP, which was launched
January 2012, tracks controlled substances (CII–V) and human growth hormone
dispensed in outpatient settings in New
Jersey and dispensed into New Jersey
in an effort to help combat prescription
drug abuse, misuse, and diversion.
Methods: This is a 6-week, institutional review board-exempt, crosssectional study of New Jersey pharmacists practicing in outpatient settings.
A sample of 495 licensed New Jersey
pharmacists will be contacted by e-mail
to participate in a voluntary, anonymous
survey using SurveyMonkey. Inclusion
criteria include: (1) pharmacists practicing in New Jersey; (2) pharmacists practicing in community pharmacy, mail
order, and hospital/clinic outpatient settings; (3) consenting subjects. Exclusion
criteria include: (1) pharmacists not licensed and/or practicing in New Jersey;
(2) practicing pharmacists who are not
subject to NJPMP reporting. The adaptive-design survey contains 1–17 items to
assess perceptions of the NJPMP, including accessibility, benefits and challenges
to use, and applicability. A percentage
of responses to each survey item will be
collated across the cohort. Descriptive
statistics will be used to analyze the information provided.
Results: Research in progress. There
are currently 79 survey respondents.
Preliminary results reveal that >98% of
subjects are registered to use the NJPMP
and 59% report accessing the NJPMP
“almost daily/daily” or “multiple times
daily.” The top 3 triggers for use are CII
analgesics, CII stimulants, and CIII–V
analgesics. A common trend with regard
to commentary is for the NJPMP to be
available to other health care practitioners, such as physicians and dentists.
j apha.org
Furthermore, respondents would like to
see future implementation of a linked,
real-time database.
284—PHARMACISTS’ USE AND
PERCEPTIONS OF A PRESCRIPTION DRUG MONITORING PROGRAM FOR CONTROLLED SUBSTANCES: A SURVEY OF CHAIN
COMMUNITY PHARMACISTS IN
TEXAS. Schulenberg S, H-E-B Pharmacy/The University of Texas at Austin
College of Pharmacy, Pope N, Lawson K,
Wilson J, The University of Texas at Austin College of Pharmacy, Weems J, Montemayor D, H-E-B Pharmacy, E-mail: [email protected]
is to assess community pharmacists’
opinions and utilization of the online
statewide prescription drug monitoring
program for controlled substances.
Methods: On August 20, 2012 the
Prescription Access in Texas (PAT) program went online for voluntary use by
any licensed Texas pharmacist willing
to enroll in the program. Once enrolled,
pharmacists can search for a patient’s
prescription dispensing history for
Schedule II–V controlled substances during the previous 365 days. Currently,
no information is available regarding
pharmacists’ use of PAT and perceived
benefits from the program. Data will
be collected from licensed community
pharmacists in Texas. Participants will
complete an anonymous online survey
designed specifically to assess pharmacists’ knowledge of the PAT program,
frequency of use, and perceptions of
its usefulness and ease of use. Data collected from this study will be analyzed to
produce an estimate of pharmacists’ use
and attitudes toward the PAT program.
This study will be submitted to the institutional review board for approval and
informed consent will be obtained from
all participants.
AWARENESS AND KNOWLEDGE OF MULTIPLE SCLEROSIS. Joshi N, Khanna
R, Holmes E, University of Mississippi
School of Pharmacy, E-mail: njoshi@
go.olemiss.edu
MA R /APR 2014 | 54:2 |
JAPhA e179
APhA2014 ABSTRACTS
Objective: Although multiple sclerosis (MS) is an incurable disease, many
drugs have been approved over the
past 2 decades to provide symptomatic
relief to patients. Pharmacists are positioned to facilitate optimal treatment of
MS by effectively managing symptoms
and providing recommendations to patients. This study examined pharmacists’
awareness and knowledge of core symptoms, etiology, and treatment of MS.
Methods: A cross-sectional, online
survey of pharmacists practicing in 7
states (i.e., Louisiana, Minnesota, Mississippi, Oregon, South Dakota, Tennessee,
and Washington) was undertaken. The
survey assessed pharmacists’ awareness
and knowledge of core symptoms, etiology, treatment, and information resources on MS. Information on demographic
and practice-based characteristics of
pharmacists also was collected. Descriptive analyses were performed on survey
data.
Results: A total of 1,096 usable responses (3.4%) were received. Most
pharmacists (86%) were not familiar
with the McDonald criteria for diagnosis of MS. One-third of the pharmacists
were not familiar with the side effects
of MS medications. Approximately 71%
of the pharmacists were unfamiliar with
information resources on MS that can be
used by patients and health care professionals. Approximately 28% of the pharmacists incorrectly believed that MS is
a rare disease. Only 1 in 4 pharmacists
indicated being confident in their ability
to counsel patients about the medication
profile and side effects of MS medications. A majority (91%) of the pharmacists agreed that they could benefit from
a continuing education or training program on MS.
Conclusion: Study results highlight
significant gaps in pharmacists’ knowledge of MS. Policy makers and national
MS organizations should consider offering MS-specific continuing education
programs to pharmacists.
286—STALL
DRUGS:
ASSESSMENT OF STUDENT SATISFACTION WITH DRUG INFORMATION
POSTERS IN LAVATORY STALLS.
Takara L, University of Hawaii at Hilo,
e180 JAPhA | 5 4:2 | M AR/AP R 2014
is to assess student pharmacists’ satisfaction with Stall Drugs as a tool for learning and retaining prescription drug information.
Methods: Stall Drugs is a learning project which places the “Top 200”
prescription drug information posters
on the inside of lavatory stall doors at
a college of pharmacy campus. Posters
contain proprietary and generic names,
common indications, dosage forms, adverse effects, contraindications, counseling tips, clinical pearls, drug images, and
comics. Each week, a unique therapeutic
class or indication is selected as the drug
theme, with a different drug represented
in each stall. Each week, a new theme
poster group replaces the previous
theme group. At the beginning of the
fall 2013 semester, all first-, second-, and
third-year doctor of pharmacy students
were invited to participate in a pre-survey conducted via SurveyMonkey. The
survey asked about the types of tools
and satisfaction with tools used to learn
about the Top 200 prescription drugs;
assessment and preparedness to utilize
Top 200 drug knowledge; and use of
campus lavatories. At the end of the fall
2013 semester, a similar post-survey will
be conducted with the same students.
The survey results will be analyzed to
determine students’ perceived improvement in drug information knowledge
and level of satisfaction with Stall Drugs.
pre-survey was completed by 70% of the
260 eligible students. The most popular
Top 200 prescription drug learning tools
were identified as tertiary drug information resources and self-made flashcards.
Student pharmacists reported using the
campus lavatories an average of 7 times
a week.
287—STUDENT
PHARMACISTS’
PERCEPTIONS OF THE QUALIFICATIONS AND RESPONSIBILITIES OF
COMMUNITY PHARMACY TECHNICIANS. Conway S, Dunican K, Abel
C, Seed S, Lynch A, Massachusetts College of Pharmacy and Health Sciences
University, E-mail: kaelen.dunican@
mcphs.edu
ja p h a .org
is to evaluate student pharmacists’ perception of the qualifications, responsibilities, and importance of community
pharmacy technicians.
Methods: An anonymous survey
was administered to student pharmacists at the conclusion of their first professional (P1) year in an accelerated
doctor of pharmacy program via Turningpoint technology. Survey questions
assessed students’ knowledge of the
qualifications and responsibilities of certified pharmacy technicians (CPhTs) in
community pharmacy and the perceived
value of community pharmacy technicians to the community pharmacy team.
Completion of the survey was voluntary
and approved by the university’s institutional review board. Data were evaluated using descriptive analyses.
Results: Of the 298 surveys administered, 282 surveys were completed
(94.6% response rate). The majority of
the P1 students were aware that CPhTs
are required to pass a licensure examination (78.4%) but only 37.2% were aware
that CPhTs are required to complete
continuing education. Less than 10% of
students felt that CPhTs were qualified
to contact prescribers regarding complex drug-related problems (DRP) and
41.5% of students felt that CPhTs were
not qualified to communicate with prescribers for any DRP. The majority of
students (92.2%) believed that pharmacy
technicians are very important to a community pharmacy team; less than 1% felt
that technicians were not important to a
community pharmacy team. In comparison, only 61.7% of students thought that
pharmacy interns were very important
to the community pharmacy team and
8.5% felt that interns were not important
to the pharmacy team.
Conclusion: Student pharmacists’
view CPhTs as more important to the
pharmacy team than pharmacy interns.
Student pharmacists are not aware of
many of the technicians’ qualifications
and their ability to assist with DRPs.
CPhTs play a critical role in community
pharmacies, and student pharmacists
should be educated about the technicians’ qualifications.
APhA2014 ABSTRACTS
288—SURVEY TO DETERMINE
PHARMACISTS’
CAPABILITIES
AND PERCEIVED VALUE OF CLINICAL INTERVENTIONS DURING
THE DISPENSING PROCESS. Lantaff W, University of Iowa College of
Pharmacy, McDonough R, Towncrest
Pharmacy, Urmie J, Catney C, Veach S,
University of Iowa College of Pharmacy,
study are to: (1) examine the perceived
financial and clinical value community
pharmacists in a Midwestern state have
on clinical interventions that occur during the medication dispensing process;
and (2) determine which factors may influence pharmacists’ abilities to address
clinical interventions in the traditional
community setting.
Methods: Interventions made by
pharmacists in the community setting
are associated with an overall cost savings to the health system in addition to
improved patient outcomes. These necessary interventions add an incremental
cost to the dispensing process, which
is generally not accounted for in current reimbursement model. Beyond the
cost burden during the dispensing process, further evaluation is also needed
to determine pharmacists’ capabilities
in making these interventions, beyond
those needed to properly dispense the
prescription, due to influencers such as
knowledge/skill, training, and work
environment. An online survey to evaluate these objectives has been developed
and will be administered through Qualtrics. A link to access the survey will be
e-mailed to the study population with
a cover letter explaining the purpose
of the study. The e-mail will be sent
through the state pharmacy association’s
list server to pharmacists who practice
within the state and who identify their
practice site as the community pharmacy
setting. The online survey will be open
from December 2013 through February
2014. Following the closing of the survey,
data analysis will occur and descriptive
statistics will be used to summarize the
survey results.
Pharmacoeconomics and Out-
comes
ries compared with 16 children (5.14%)
who received medication.
289 —AT T EN T ION-DEF ICI T/ H YPERACTIVITY DISORDER MEDICATIONS AND INJURIES AMONG
CHILDREN. Chen Z, Goedken A, University of Iowa, E-mail: [email protected]
Objective: Children with attentiondeficit/hyperactivity disorder (ADHD)
are at higher risk for accidental injuries.
Though the clinical efficacy of ADHD
medication on reducing ADHD symptoms is well established, there is limited
knowledge of the effect of ADHD medications on injuries among children with
ADHD. The objectives of this study are
to: (1) estimate the association between
ADHD medication and injury rate
among children with ADHD; and (2) assess the types of injuries suffered by children with ADHD who receive and do
not receive ADHD medication.
study pools 8 panels of data from the
Medical Expenditure Panel Survey spanning the years 2002 to 2010. The study
sample is required to: (1) be eligible and
participate in all 5 rounds of a panel; (2)
be ≤18 years old at ADHD diagnosis; (3)
have ADHD diagnosed in rounds 2, 3, or
4 of the survey; (4) have no exposure to
ADHD medications in the round prior to
ADHD diagnosis; and (5) have no injury
during the round of ADHD diagnosis.
The outcome variable is the injury rate
during the round after a child is diagnosed with ADHD. The exposure variable is whether a child receives an ADHD medication in the round of diagnosis. The covariates include age, sex, index
round, and previous injury. Descriptive
statistics will characterize the demographics and injuries of the medicated
and non-medicated groups. A multiple
regression model will be used to examine the association between ADHD medication and injuries.
total of 527 children are included in the
study, of which 311 (59%) received ADHD medication and 216 (41%) did not receive ADHD medication. Twenty-seven
children (5.1%) experienced at least 1
injury. Eleven children (5.09%) who did
not receive medication experienced inju-
j apha.org
290—AVERAGE ANNUAL COST
OF PROSTATE CANCER AND FACTORS PREDICTING THE COST.
Patel P, Shah S, Tackett R, University of
Georgia, E-mail: [email protected]
is to: (1) explore annual average prostate
cancer cost per patient based on type of
visit, age, and race/ethnicity; and (2) explore the significant predictors of annual
cost of prostate cancer among age, race,
and type of visits.
study involving the use of 2010 Medical Expenditure Panel Survey database.
Data for patients with prostate cancer
was extracted using the International
Classification of Diseases–9th revision
(ICD-9) code. One-way analysis of variance analyses were used to find the average annual prostate cancer–related costs,
and multivariate regression was carried
out to examine the impacts of age, race,
and types of services on total costs in SAS
software.
Results: The average annual prostate cancer expenditure per patient on
drug purchase, inpatient, outpatient,
and office-based visits was found to
be $6,177.2, $5,169.4, $3,679.71, and
$1,149.86 respectively. Hispanic patients
aged 45 to 64 years spend an average of
$5,060.08 on prostate cancer–related expenses while in the age category of 75 to
90 years, they spend $17,220.55, which
is significantly higher than any amount
spent by any other ethnic background in
that age category in 2010. Overall, prescription cost and outpatient visits were
the statistical significant predictors of annual costs of prostate cancer.
Conclusion: Drug purchase or medications were found to be most expensive
while prescription cost and outpatient
visits influence the cost of prostate cancer. To reduce costs associated with prostate cancer, conservative management
and proper pharmacist-provided counseling to these patients are suggested as
the most important strategies.
291—CAN HIGHER RATES OF CARDIOVASCULAR DRUG USE INMA R /APR 2014 | 54:2 |
JAPhA e181
APhA2014 ABSTRACTS
CREASE SURVIVAL FOR PATIENTS
WITH END-STAGE RENAL DISEASE? AN INSTRUMENTAL VARIABLES INVESTIGATION. Tang Y,
University of Iowa, Brooks J, University
of South Carolina, Wetmore J, Shireman
T, University of Kansas, E-mail: [email protected]
Objective: Cardiovascular (CV) disease is a leading cause of death and morbidity among patients with end-stage renal disease (ESRD). However, utilization
rates of CV drugs for patients with ESRD
vary substantially across the United
States. The objectives of this study are to
examine the comparative effectiveness
of CV drugs among patients with ESRD
and determine whether higher utilization rates improve survival.
Methods: Risk adjustment and instrumental variables models were used
to estimate the comparative effectiveness
of CV drugs on survival of patients with
ESRD. Medicare/Medicaid dual-eligibles with ESRD who initiated dialysis
during 2000–2004 were selected using
U.S. Renal Data System and Medicaid
Analytic eXtract data (n = 50,468). Treatments included angiotensin-converting
enzyme inhibitors/angiotensin receptor
blockers, calcium channel blockers, betablockers, and HMG-CoA reductase inhibitors (i.e., statins) within 90 days post
dialysis. Area treatment ratios (ATR)
were instruments created for each CV
drug category. Both models were adjusted for patient demographic characteristics, comorbidities, and functional status.
Results: Risk adjustment estimates
suggest that CV drug use provided survival benefits to ESRD patients who received them. However, ESRD patients
receiving CV drugs tended to have more
comorbidities, suggesting that risk adjustment estimates are biased low. Substantial variation in ATRs of CV drugs
were found across the United States
that are strongly related to CV drug use.
Fewer clear relationships were found
between measured covariates and ATR
groups than treatment groups. Instrumental variables estimates suggested
that higher rates of beta-blocker use statistically significantly increased 1-year
survival, but no survival benefits were
found in other CV drug categories.
e182 JAPhA | 5 4:2 | M AR/AP R 2014
Conclusion: Instrumental variables
estimates suggest that only higher rates
of beta-blocker use by ESRD patients are
associated with improved survival. With
limited information on comparative effectiveness found from randomized
controlled trials, this study represents
an important advancement in the understanding of real world CV therapeutic
effectiveness and whether higher utilization rates are warranted in CV drugs.
292—COST-CONSEQUENCE ANALYSIS OF A COMMUNITY PHARMACY RESIDENT. Branson R, Kieser
M, Kreling D, University of Wisconsin
School of Pharmacy, E-mail: rbranson@
wisc.edu
Objective: The objectives of this case
study are to examine whether the value
of a pharmacy resident outweighs the
cost of maintaining a pharmacy resident
and to explore patient interest in services
offered by a pharmacy resident.
Methods: A cost-consequence analysis will be used to determine the value
of a community pharmacy resident to a
site that had never previously had a resident. The direct and indirect costs to the
site of maintaining a pharmacy resident
for a period of 1 year will be examined
and compared with the consequences
of having a pharmacy resident present
at the site. Consequences will be identified based on activities completed by
the resident while at the residency site
including, but not limited to, number of
medication therapy management services performed, number of patients served
in anticoagulation and tobacco cessation
clinics, prescription volume, number of
provider drug information questions answered, and increased utilization of electronic health record by pharmacy services as evidenced by number of templates
generated by the resident and number
of times those templates are used. Patient interest in receiving services from a
pharmacist also will be measured by preand post-surveys directed toward asthma patients before and after initiation of
a pharmacist-managed asthma care clinic. These surveys will examine patient
perception of the care they are currently
receiving, whether they feel pharmacists
are qualified to provide such services,
ja p h a .org
and what benefits they perceive from
pharmacist-managed services. Data will
be collected over 2 months and extrapolated to fit the 10-month time frame of active residency.
293—ESTIMATING THE ECONOMIC BURDEN OF TREATING INCOMPLETE MISCARRIAGE IN THE BAHAMAS. Sakharkar P, Roosevelt University College of Pharmacy, Sakharkar
V, University of the West Indies School
of Clinical Medicine and Research, Email: [email protected]
Objective: Incomplete miscarriage
is the most common gynecological problem with an estimated incidence ranging
from 15% to 30% of all diagnosed pregnancies. It is one of the leading causes
of emergency department visits and
gynecological admissions. Incidence of
incomplete miscarriage is approximately
15% of total births in the Bahamas every year. Besides hospital costs, cases of
incomplete miscarriage take up hospital beds and consume operating room
resources. The aim of this study was to
estimate the economic burden of incomplete miscarriage on the publicly funded
health care system in the Bahamas.
Methods: A 5-year data collection on
number of admissions, outpatient treatment, and medical and surgical management of miscarriages was reviewed from
the largest hospital in the Bahamas. Cost
of medical and surgical treatment was
calculated separately. It included direct
and indirect costs as follows: physician
cost, procedure cost, cost of ultrasounds,
drug cost, cost of hospital stay, costs of
complications and adverse events as
well as loss of wages and cost of travel.
Costs were derived from annual hospital
financial report, national labor and wages statistics, and the published literature.
Results: Total miscarriages accounted for 15% of all gynecological
admissions with an average inpatient
hospital stay of 2.4 days. The majority
(88%) of miscarriages were managed by
surgical evacuation, of which (38%)
were managed in hospital and 62% were
managed on an outpatient basis. Only
12% were treated medically. The average cost of inpatient surgical treatment
APhA2014 ABSTRACTS
was $2,393 and as an outpatient $1,843.
The cost of medical treatment was $926.
The overall cost of treating incomplete
miscarriage in the Bahamas accounts for
over $1,048,460 each year, translating to
$1,906 per patient. This burden can be reduced to $323,496 (31%) by maximizing
outpatient surgical and medical management.
Conclusion: Incomplete miscarriages are substantial burden on the
publicly funded health care system in the
Bahamas. Use of outpatient surgical and
medical treatment can reduce this cost
burden significantly.
294—EVALUATION OF RETURNTO-STOCK MEDICATIONS IN TWO
COMMUNITY PHARMACIES. Jaber
A, Gavin R, Coley K, University of Pittsburgh, E-mail: [email protected]
Objective: The study goal is to
determine trends existing among prescriptions that are “returned to stock”
in community pharmacy settings in order to identify contributing factors and
characteristics of prescriptions that are
not picked up by patients to develop improvements in the future.
Methods: This study was conducted
at 2 community pharmacy locations
within 2 different chains in western
Pennsylvania, where the mutual need
to reduce the amount of prescriptions
being returned to active pharmacy stock
due to patient failure to pick up was
identified. Prescription medications
that were returned to stock were identified through the use of automatically
generated daily return to stock reports.
For each medication, the following variables were collected within a span from
June 1, 2013 until August 1, 2013: patient
date of birth, sex, and zip code; medication name, cost, third-party information,
method of prescription transmission,
prescription enrollment in automatic refills, first fill or refill, site 1 or 2, and the
overall number of prescriptions picked
up by that patient in the previous 30 days
from date of return. These data will be
analyzed using SPSS software to determine trends among the returned to stock
prescriptions. This study was approved
by the university’s institutional review
board.
Results: Research in progress. Time
management in community pharmacy is
becoming increasingly important as focus shifts from the dispensing role of the
pharmacist to the provision of patient
care services. This research is intended
to identify a starting point from which to
develop strategies aimed at reducing the
amount of medications returned to stock
in community pharmacies in order to optimize use of time and resources.
295—THE IMPACT OF MEDICARE
PART D COVERAGE ON HEALTH
OUTCOMES IN PATIENTS WITH
END-STAGE RENAL DISEASE. Park
H, University of Florida, Rascati K, Lawson K, Barner J, Richards K, The University of Texas at Austin, Malone D, The
University of Arizona, E-mail: hpark@
cop.ufl.edu
Objective: Medicare Part D coverage gap involves substantial periods
of uncovered drug use. The purpose of
this study was to evaluate the impact of
Medicare Part D coverage on health outcomes in patients receiving dialysis.
Methods: A retrospective analysis (2006–2010) was conducted using
data from the United States Renal Data
System for Medicare-eligible patients
receiving dialysis. Medication adherence, health care utilization and expenditures, cardiovascular disease morbidity, and mortality rates were compared,
categorized based on patients’ Part D
coverage in 2007 for those who: (cohort
1) did not reach the coverage gap; (cohort 2) reached the coverage gap but not
catastrophic coverage; (cohort 3) reached
catastrophic coverage; and (cohort 4) did
not reach the coverage gap but received
a low-income subsidy. Cox proportional
hazard models, Kaplan-Meier methods,
logistic regressions, generalized linear
models, and generalized estimating
equations were used.
Results: A total of 11,732 patients
were identified. Patients in cohort 2
were more likely to be nonadherent to
medications for diabetes (relative risk
[RR] = 1.71, 95% confidence interval [CI]
= 1.48–1.99), hypertension (RR = 1.69;
95% CI, 1.54–1.85), hyperlipidemia (RR
= 2.01, 95% CI 1.76–2.29), hyperphosphatemia (RR = 1.74, 95% CI 1.55–1.95),
j apha.org
and hyperparathyroidism (RR = 2.08,
95% CI 1.66–2.60) after reaching the
coverage gap. These patients had $2,419
lower pharmacy costs, but $3,368 higher
medical service costs (P<0.001) due to
increased rates of hospitalization (1.73
vs. 1.58) and outpatient visits (7.98 vs.
6.95) compared with patients in cohort 4
(P<0.05). In addition, patients in cohort 2
and cohort 3 had 42% and 38% increased
risk of cardiovascular disease (odds ratio
[OR] = 1.42, 95% CI 1.20–1.68 and OR =
1.38, 95% CI 1.10–1.72); and had 36% and
37% higher mortality rates compared
with those in cohort 4, respectively (hazard ratio [HR] = 1.36, 95% CI 1.27–1.44
and HR = 1.37, 95% CI 1.27–1.48). These
relationships remained significant for
the propensity-score matched and fully
adjusted models controlling for laboratory data.
Conclusion: Reaching the Part D
coverage gap was associated with decreased medication adherence and unfavorable clinical and economic outcomes
in patients undergoing dialysis.
296—IMPACT OF PRIOR AUTHORIZATION OF MONTELUKAST
ON CLINICAL OUTCOMES FOR
ASTHMA AND ALLERGIC RHINITIS AMONG CHILDREN AND
ADOLESCENTS IN A STATE MEDICAID PROGRAM. Keast S, Harrison
D, University of Oklahoma College of
Pharmacy, Thompson D, University
of Oklahoma College of Public Health,
Farmer K, Smith M, University of Oklahoma College of Pharmacy, Nesser N,
Oklahoma Health Care Authority, Email: [email protected]
Objective: As policy makers struggle with increasing membership and
limited resources, restrictions are often
placed on costly pharmaceuticals when
more cost-effective products are available. Restrictions in fragile disease states
must be reviewed to ensure unintended
clinical consequences do not occur.
Oklahoma Medicaid implemented such
a restriction on montelukast in January
2009. The objective of this research was
to evaluate potential unintended clinical
consequences of the restriction on patients with asthma and allergic rhinitis.
Methods: Monthly individual-level
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APhA2014 ABSTRACTS
data were collected from Oklahoma
Medicaid paid pharmacy and medical
claims from January 1, 2007 through December 31, 2010 for children and adolescent beneficiaries with asthma and/or allergic rhinitis. Continuous eligibility for
the entire 48-month period was required.
The effect of the prior authorization for
montelukast on emergency room (ER)
utilization, disease-related physician office visits (DRV), and antibiotic prescription utilization (ABX) was analyzed using segmented binomial regression.
Results: For all 3 outcomes, decreases in mean number of claims per member
per month were detected when comparing pre– and post–prior authorization
periods for the disease states of asthma,
allergic rhinitis, or both. Odds of having an outcome of interest at the point
of prior authorization implementation
was 0.71 (P<0.0001), 1.29 (P<0.0001), and
1.26 (P<0.0001) for ER, DRV, and ABX
respectively. Overall trend in odds was
1.02 (P<0.0001), 0.93 (P<0.0001), and 0.95
(P<0.0001) for ER, DRV, and ABX, however during the post-implementation
period, the odds were 0.92 (P<0.0001)
for ER and 1.03 (P<0.0001) for DRV and
ABX.
Conclusion: While there was a point
increase at implementation for DRV and
ABX, the overall trend remained negative, indicating that no unexpected negative clinical outcomes occurred. Additionally, the results indicate no negative
effect was detected in ER utilization after
prior authorization implementation, especially in patients with asthma.
297—IMPLICATIONS OF WASHOUT PERIOD DURATION IN INCIDENT USER STUDY DESIGNS IN
COMMERCIALLY INSURED POPULATIONS. Roberts A, University of
School of Pharmacy, Dusetzina S, University of North Carolina at Chapel Hill
School of Medicine, Farley J, University
of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected]
Objective: This project aims to describe the effect of “washout” period
duration on the composition of retrospective incident user cohorts. Incident
e184 JAPhA | 5 4:2 | M AR/AP R 2014
user study designs reduce bias in observational studies by excluding patients
with prior drug exposures. Increasing
washout period duration ensures more
accurate identification of incident users
at the expense of generalizability and
precision. Little evidence exists to guide
researchers in selecting appropriate
washout periods.
Methods: This study used Truven
Health Analytics MarketScan database
from 2007 to 2010. Individuals aged 18
to 64 years with a prescription claim in
calendar year 2010 for a medication approved to treat hyperlipidemia, diabetes, or depression were included. For
each cohort, 5 increasingly restrictive
washout periods (i.e., 3, 6, 12, 24, and 36
months) were applied to identify incident users with continuous enrollment.
Changes in cohort sample size across
washout durations were described.
Rates of incident user misclassification
for each cohort were assessed as washout duration decreased.
Results: Among the 3,477,753 antihyperlipidemic, 1,445,651 antidiabetic,
and 3,468,137 antidepressant users
identified, a 3-month washout reduced
the sample by 54%, 61%, and 56%, respectively. Twelve-month washouts
reduced the antihyperlipidemic and
antidiabetic cohorts by 87% and the antidepressant cohort by 83%. A 36-month
washout reduced each cohort by 95%.
Continuous enrollment gaps accounted
for nearly half of observed sample loss
in 3- to 12-month washouts and roughly
70% of observed sample loss in longer
washouts. Incident user misclassification rose as washout duration decreased.
Twelve-month washouts resulted in
misclassification of 33%, 26%, and 32%
of antihyperlipidemic, antidiabetic, and
antidepressant users, respectively. Misclassification rates were 45% to 50% for
6-month washouts and 67% to 77% for
3-month washouts.
Conclusion: Washout period duration significantly impacts the size and
accuracy of retrospective incident user
cohorts. These trends were similar for
medications used for both chronic and
episodic conditions. Researchers should
be aware that washout periods of 6 to 12
months may be insufficient for identifyja p h a .org
ing treatment-naive patients.
298—IMPROVING COST SAVINGS
AND PATIENT OUTCOMES WITH
HEPATITIS C TRIPLE THERAPY
TREATMENT IN THE MEDICAID
POPULATION. Chen Y, Carter C, Fish
M, PerformRx, Mayer D, University of
Pittsburgh School of Pharmacy, E-mail:
[email protected]
Objective: This study aims to use
several simple approaches to contain
rising costs and provide better care for
patients with hepatitis C patients in this
Medicaid population. Throughout the
entire process, comparisons will include
costs and member outcomes from the
study approach to the baseline before
these initiatives took effect. Overall, if
cost control and improved member outcomes are successful with the hepatitis
C population, then these processes also
may be applied to other disease states,
clients, and members in an effort to manage total health care costs and outcomes.
Methods: For a Pennsylvania Medicaid population, more restrictive parameters were implemented on the prior
authorization criteria to reflect changes
in the recommended treatment regimen.
In addition, this institution’s current patients with hepatitis C will be monitored
throughout their entire duration of treatment starting from March 2013 until the
end of treatment by obtaining their refill
history, laboratory values, and prior authorization data for any hepatitis C triple
therapy request. Providers and patients
would be contacted if interventions are
necessary. Furthermore, tablet computers will be used to give more insight into
and improve adherence. These tablet
computers would mainly push questions and reminders to members to take
their medications and have necessary lab
work drawn on time. Through an online
portal, answers to the questions can be
reviewed for the purpose of analyzing
attitudes and adherence rates and determining necessary interventions.
299—PATTERNS OF ADHERENCE
AND HEALTH SERVICE UTILIZATION AMONG UNIVERSITY OF
NORTH CAROLINA HEALTH CARE
APhA2014 ABSTRACTS
PHARMACY ASSISTANCE PROGRAM ENROLLEES WITH CHRONIC DISEASE. Roberts A, University of
School of Pharmacy, Crisp G, University
of North Carolina at Chapel Hill Hospitals and Clinics, Esserman D, Yale School
of Public Health, Roth M, University of
School of Pharmacy, Weinberger M, University of North Carolina at Chapel Hill
Gillings School of Global Public Health,
Farley J, University of North Carolina at
was to examine medication adherence
and health care utilization among patients with chronic disease enrolled in
a charitable pharmacy assistance program. Charitable pharmacy assistance
programs are prevalent and provide
medications to financially vulnerable patients, who are at greater risk of suboptimal medication adherence and health
outcomes. However, little is known
about the utilization patterns of program
members.
Methods: This study used a retrospective cohort design to investigate
6-month outcomes for new University of
North Carolina Health Care Pharmacy
Assistance Program (UNCH PAP) members receiving medications indicated
for hypertension, diabetes, and/or hyperlipidemia during 2009 to 2011. The
study describes medication adherence
(measured in proportion of days covered
[PDC]) and health care utilization patterns for antihypertensive, antidiabetic,
and statin user cohorts. Logistic regression was used to analyze predictors of
adherence and evaluate the association
between adherence and emergency and
inpatient care utilization, while controlling for demographic and select utilization characteristics.
Results: The cohorts included 866,
265, and 455 UNCH PAP members using antihypertensive, oral antidiabetic,
and statin medications, respectively.
Average 6-month adherence, in PDC, for
antihypertensive, oral antidiabetic, and
statin user cohorts was 0.70, 0.67, and
0.60, respectively. Approximately 40%
to 50% of subjects were adherent at PDC
≥0.8. Nearly 20% were hospitalized at
least once and over 25% received emergency care during the observation period. Regression analyses suggested that
multiple comorbidities and adherence
were associated with reduced inpatient
and emergency care.
Conclusion: UNCH PAP was a primary source of care for many low-income, uninsured North Carolinians. The
findings suggest that PAPs can provide
access to consistent pharmacy care and
reduce costly health care utilization, particularly among older, complex patients.
The future viability of charitable PAPs to
achieve positive health outcomes, particularly in states like North Carolina that
are opting out of Medicaid expansion,
may require further research and integration of medication therapy management services.
300—PREDICTING IMMUNOGENICITY OF INFLIXIMAB: PHARMACOECONOMIC IMPLICATIONS
FOR BIOSIMILARS. Andrick B,
Stroyne K, Kamal K, Meng W, Duquesne
was to predict immunogenicity of infliximab in the context of perceived economic benefit of biosimilars. Biosimilars
are products containing the same active
biologic ingredients, with similar physiochemical and clinical performance. The
anticipated cost-saving has generated
strong interests among third-party payers. However, manufacturing of biologics is complex; slight product deviance
may result in drug-specific antibody
responses. A thorough pharmacoeconomic evaluation must consider immunogenicity-related adverse drug events
and not just drug acquisition costs. In the
present study, the amino acid sequence
of infliximab was analyzed for antigenic
and aggregation potential, both factors
contributing to induction of antibodies.
Methods: The antigenic potential
of infliximab was evaluated using the
bioinformatics tool SYFPEITHI. The sequence was screened for peptides that
conform to the binding motif of HLADRB1*1001, human major histocompatibility molecules (MHC) linked to rheumatoid arthritis. Aggregation propen-
j apha.org
sity was analyzed using the prediction of
amyloid-structure aggregation (PASTA)
algorithm. Proteins are more likely to enter MHC pathways when aggregate. The
pharmacoeconomic framework needs to
address budget impact of introducing
the biosimilars in the formulary.
Results: Scanning infliximab for
HLA-DRB1*1001 motif yielded GPIYKRVDGKWMREL (light-chain residues 94-109) as a potential ligand. This
fragment resembles the influenza A virus nucleocapsid segment YKRVDGKWVRELVLYDK, also a potential ligand
of HLA-DRB1*1001. The resemblance
suggests patients exposed to the influenza may be sensitized toward infliximab.
PASTA analysis identified several segments in infliximab that may drive beta-fibril–like aggregation. Inflectra and
Remsima are 2 biosimilar products of infliximab that have been approved by the
European Medicines Agency. The acquisition costs (per 100 mg) of the biosimilars are $399.99 versus Remicade (infliximab) product which is $665.65. Future
pharmacoeconomic framework should
weight the lower acquisition costs of the
biosimilars against costs incurred from
adverse events, if any. The results will
help payers decide the true value of these
biosimilar drugs.
301—SHORTAGES OF ONCOLOGY
DRUGS IN THE UNITED STATES.
Greene N, Turkistani F, Seoane-Vazquez
E, Massachusetts College of Pharmacy
and Health Sciences, Rodriguez-Monguio R, University of Massachusetts
School of Public Health and Health Sciences, Fox E, University of Utah Hospitals and Clinics, Szeinbach S, The Ohio
Objective: Shortages of oncology
products adversely impact health outcomes and health care costs. The objectives of this study were to: (1) assess the
prevalence of shortages of oncology
products; and (2) evaluate the characteristics of the products in short supply
as reported by the American Society of
Health-System Pharmacists (ASHP) in
the United States on December 31, 2012.
Methods: Drug approval data were
collected from the U.S. Food and Drug
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APhA2014 ABSTRACTS
Administration (FDA) webpage. Shortage data were collected from the ASHP
webpage. The unit of analysis was the
active ingredient(s) and route of administration. The prevalence of shortages
was estimated as a percentage of the total
number of products in the U.S. market as
of December 31, 2012.
Results: ASHP listed a total of 435
products in shortage/discontinued (237
current shortages, 166 resolved shortages, and 32 discontinued products). This
study excluded analysis of 2 devices, 3
nontherapeutic biologics, 15 vaccines,
and 58 non-FDA approved products. A
total of 36 of the products in shortage/
discontinued were approved by the
FDA for oncology indications (20 current
shortages, 14 resolved shortages, and 2
discontinued products). The prevalence
of shortages/discontinuations for oncology products was estimated at 21.3%
(36 shortages out of 169 FDA-approved
products). The prevalence for products
for all other therapeutic classes was estimated at 13.9% (321 shortages out of
2,310 FDA-approved products). Reasons for oncology drug shortages were
manufacturing (64.9%), discontinuations
(8.1%), business decision (5.4%), product
sold to another company (2.7%), raw materials (2.7%), change in manufacturing
(2.7%), and unknown reasons (13.5%).
Conclusion: Over one-sixth of the
oncology products available in the
United States were reported in short supply/discontinuation in December 2012.
Problems with manufacturing and discontinuations represented most of the
reported causes of shortages. Additional
research is needed to assess the risk factors, causes, and clinical and economic
impact of pharmaceutical shortages in
the United States.
302—TREATMENT
PATTERNS
AMONG PATIENTS WITH BREAST
CANCER IN THE UNITED STATES
DURING 2006–2010 USING TWO
NATIONAL SURVEYS ON VISITS
TO PHYSICIANS’ OFFICES AND
HOSPITAL OUTPATIENT DEPARTMENTS. Wittayanukorn S, Qian J,
Hansen R, Auburn University Harrison
School of Pharmacy, E-mail: szw0022@
tigermail.auburn.edu
e186 JAPhA | 5 4:2 | M AR/AP R 2014
is to: (1) estimate the patterns of antineoplastic agents prescribed to nationally
representative patients with breast cancer in ambulatory settings; and (2) identify factors associated with the antineoplastic agents prescribed.
Methods: A cross-sectional, retrospective analysis using the National
Ambulatory Medical Care Survey and
National Hospital Ambulatory Medical Care Survey data for 2006–2010 was
conducted. Patients with breast cancer
were identified by their primary diagnosis. Breast cancer treatments were categorized by medication class and further
grouped as novel, classical, and hormone
agents. A visit-level descriptive analysis
using visit sampling weights estimated
national prescribing trends. Weighted
chi-square tests examined differences in
treatment pattern across patient demographic, health insurance, and setting.
Multivariable logistic regression identified factors associated with antineoplastic agent use.
Results: Based on 2,281 breast cancer visits (weighted n = 29,116,697), antineoplastic agents were documented
in 20.52% of visits in 2006, compared
with 24.53% in 2010 (P>0.05 across
years). Hormones were the most commonly prescribed antineoplastic agents
(54.07%) followed by mitotic inhibitors
(17.74%) and HER2 inhibitors (9.79%).
Logistic regression analyses found that
patients with distant stage cancer were
more likely than patients with other
cancer types to receive anticancer agents
(odds ratio [OR] = 2.88; 95% confidence
interval [CI] 1.04–6.01), and in particular
novel (OR = 5.87; 95% CI 1.81–8.99) and
classical agents (OR = 6.34; 95% CI 1.69–
8.05). Patients with older age, comorbid
depression and diabetes, and living in
the Midwest were less likely to receive
novel agents (P<0.05 for all). Patients
having private insurance were less likely
to receive classical agents, while patients
seen in office-based clinics were more
likely to receive classical agents (P<0.05
for all).
Conclusion: The proportion of patients with breast cancer receiving ambulatory treatment is increasing over time.
Factors predicting type of treatment inja p h a .org
clude age, region, insurance type, certain
comorbidities, and setting. These findings have implications for research on
treatment access, health disparities, and
comparative effectiveness research.
Professional Development
303—EMPLOYER SUPPORT OF
POLITICAL ADVOCACY. Woods J,
Pruchnicki M, Sweaney A, The Ohio
Objective: Research has defined
professional advocacy for pharmacy
as a commitment and participation in
advancing awareness of the profession
to various stakeholders. Political advocacy in particular directs efforts toward
influential leaders and policy makers.
Pharmacists not engaged in political advocacy have reported that employer support would facilitate their participation,
thus offering a potential opportunity to
enhance pharmacists’ political involvement. The objectives of this study are to:
(1) explain the perceived value of political advocacy from community pharmacy employers’ perspectives; (2) compare
the opportunities, resources, and support employers may provide their pharmacists to engage in political advocacy;
(3) and suggest a practical approach for
employers to consider support of employees’ advocacy efforts.
Methods: Research will be conducted using an explanatory, multiple
case study approach with qualitative
and quantitative data collected through
structured interviews. Participants will
include community pharmacy department leaders recruited through purposive sampling. After obtaining consent,
subjects will participate in personal or
telephonic standardized interviews. Interviews will include both focused and
open-ended questions regarding beliefs
and company-specific practices related
to employees’ advocacy activities. Data
collection and analysis will be conducted
simultaneously through a standard iterative approach. This process will allow
for adjustment of interview questions
based on input of preceding interviews.
Investigators will conduct interviews
until the sample is exhausted or data sat-
APhA2014 ABSTRACTS
uration occurs. Interview transcripts will
be reviewed and data reported through
themes and cross-case synthesis; these
will be organized to develop representative employer advocacy models. Models
should describe broad, aggregate generalizations regarding advocacy practices
and provide specific examples of successful engagement.
Conclusion: The models generated
from this research could potentially influence employers and professional
organizations to promote successful
political advocacy engagement. Conclusions also could provide opportunities
for pharmacists to influence the formation of corporate advocacy agendas and
stimulate grassroots advocacy efforts.
304—EVALUATING THE EFFECTIVENESS OF A MEDICAL SPANISH TRAINING COURSE FOR COMMUNITY PHARMACISTS. Andres L,
Fletcher L, Fagen Pharmacy, Gonzalvo J,
E-mail: lindsey.andres@fagenpharmacy.
com
Objective: This study aims to determine the effectiveness of a medical Spanish education course for training community pharmacists.
Methods: This study has been approved by the institutional review board.
Data will be collected from pharmacists
who will be attending a medical Spanish training session tailored toward
the needs of a community pharmacist.
Training modules will be developed by
the research team and will be designed to
be brief and available online to provide
a novel, more practical training environment for today’s community pharmacist.
The focus will be on basic pronunciation,
pharmacy-related vocabulary, and necessary phrases for accurate dispensing of
prescriptions. Prior to training sessions,
pharmacists who agree to participate in
the study will complete a pre-training assessment. Upon completion of the training course, a second assessment will be
administered to assess objective and subjective medical Spanish language skills.
The primary outcome measured will be
pharmacists’ ability to recognize and use
Spanish language in a pharmacy. This
outcome will be assessed by comparison
of pre- and post-training responses to an
objective assessment of language skills.
The assessment will include Spanish language necessary to perform typical pharmacy functions such as obtaining pertinent information from patients, verifying accuracy of a prescription processed
in Spanish, and providing basic medication counseling. The secondary outcome
will measure self-efficacy with Spanish
skills. A 5-point Likert-type scale will be
used to assess pharmacists’ confidence
in their ability to perform typical pharmacy functions with Spanish-speaking
patients. Comparison of data collected
from pre- and post-training assessments
will allow for evaluation of the impact of
training sessions on pharmacists’ ability
to utilize medical Spanish.
305—EVALUATION OF A COMMUNITY PHARMACY SUMMER INTERN PROGRAM MANUAL. Vahle
L, Wilhelm M, Southern Illinois University Edwardsville, E-mail: lvahle@siue.
edu
is to evaluate the effectiveness of a learning tool (i.e., a program manual) for a
summer intern program that provided
student pharmacists with self-care topics
and community pharmacy experience
throughout a 10-week program.
Methods: A 20-question data collection tool was developed as a pre- and
post-quiz for student pharmacists completing a 10-week summer intern program. Interns were instructed to make a
unique identifier to maintain anonymity
but allow for pre- and post-quiz comparisons. The pre- and post-quiz consisted
of 2 multiple-choice self-care–related
questions taken from each week of a
previously developed summer intern
program manual. Interns completed
the quiz on the first and last days of the
10-week summer intern program. Upon
completion of the summer intern program, interns also completed a 9-question perception survey. The perception
survey utilized a 5-point Likert scale
with questions related to how the manual assisted with learning of self-care–re-
j apha.org
lated topics. The study was approved by
the institutional review board as exempt
category of research.
Results: All 4 interns (100%) participating in the summer intern program
completed the pre- and post-quiz. Preand post-quiz scores were analyzed using descriptive statistics. Mean intern
quiz scores improved from 20% initially
to 69% after completion of the summer
intern program and manual. Overall perception survey results were positive with
interns consistently agreeing or strongly
agreeing that the manual for the summer intern program contributed to their
learning.
Conclusion: Mean pre- and postquiz scores and perception survey results indicate the summer intern program manual is an effective learning
tool. All interns reported they would recommend the program to other student
pharmacists.
306—INTRODUCTORY LEARNING
MODULES FOR DRUG DOSAGE
FORMS AND DELIVERY ROUTES.
Horner J, Brock T, Chen X, Ferrone M,
Floren L, University of California–San
Francisco, E-mail: [email protected]
Objective: The goal of this project
was to provide novice pharmacy students with a consolidated and technologically enhanced introduction to drug
dosage forms and delivery routes to
eventually apply this knowledge in further coursework and internships.
Methods: The project includes 5
phases which were adapted from the
Kern methodology, a validated method
of curriculum development: (1) review
of current practices; (2) curriculum design; (3) creation of media; (4) implementation; and (5) evaluation. Phase
1 involved a review of which topics in
drug dosage forms and delivery routes
were currently covered in which courses
across the curriculum to identify gaps,
inefficiencies, and areas of confusion. In
phase 2, a curricular outline was developed for 5 audiovisual learning modules:
introduction to dosage forms, oral delivery, parenteral delivery, delivery via
inhalation, and topical delivery. Next,
learning objectives and technical content
were detailed for each module including
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APhA2014 ABSTRACTS
a unifying patient case, pictures, videos,
and supplementary resources. In phase
3, the multimedia modules were created using Articulate Presenter. In phase
4, the modules were launched to all the
first-year pharmacy students (N = 120).
For phase 5, the (validated) Kirkpatrick
model will be used for evaluating student reaction, learning, behaviors, and
results. This includes both phased online
student surveys (e.g., satisfaction, recommendations for improvement, practicality for internship) and instructor surveys (e.g., perceptions of preparedness,
cohort grade comparisons).
Results: Research in progress. Initial satisfaction surveys were very positive. Students appreciated the content
of the modules and enjoyed the media
platform used. Further evaluation next
year will show if this project will have a
positive effect on students’ preparation
for more advanced courses and clinical
internships.
307—PHARMACISTS AS CERTIFIED ASTHMA EDUCATORS (AEC): WHAT IS THE IMPACT OF THE
AE-C AND WHY AREN’T MORE
PHARMACISTS CERTIFIED?. Hudd
T, Seoane-Vazquez E, Massachusetts
College of Pharmacy and Health Sciences University, Bollmeier S, St. Louis
College of Pharmacy, E-mail: tim.hudd@
mcphs.edu
study is to gather insight from pharmacists who have successfully completed
the certified asthma educator (AE-C)
exam to better gauge how the National
Asthma Educator Certification Board
(NAECB) may further promote or recruit
pharmacists to sit for this examination.
Methods: A questionnaire was developed, validated, and pretested by
pharmacists with expertise in asthma
education. The final 20-item survey was
distributed to the 224 pharmacists nationwide with an active AE-C credential using the Constant Contact Online
Survey Tool on April 6, 2013. Participation was voluntary and results were
reviewed using descriptive statistical
analyses.
Results: Of the 224 AE-C pharmacists surveyed, a total of 57 (25.4%) phar-
e188 JAPhA | 5 4:2 | M AR/AP R 2014
macists from 30 states fully completed
the survey. Fourteen pharmacists not
directly involved in patient care–related
activities were excluded from analysis.
Respondents were primarily female
(83.3%); had earned a doctor of pharmacy degree (84.7%); completed a postgraduate year 1 residency (42.9%); and
were practicing in an ambulatory care
setting (57.1%). Respondents considered
that the AE-C certification had helped
advance them professionally, with 24.4%
of the respondents strongly agreeing,
48.9% somewhat agreeing, 22.2% neither agreeing nor disagreeing, and 4.4%
somewhat disagreeing. The majority of
respondents (84.4%) indicated that they
would recommend the AE-C credential
to a pharmacist colleague.
Conclusion: The National Asthma
Education and Prevention Program has
advocated for multifaceted educational
programs to improve self-management
skills and asthma outcomes. As the pharmacists’ role continues to evolve, the
ability to demonstrate competence in
specialty areas of practice will be increasingly important. As the NAECB continues to promote the AE-C certification
among all eligible health care provider
groups, increased efforts to raise awareness around this credential among pharmacists demands exploration.
308—STUDENT
UTILIZATION
OF PROFESSIONAL PHARMACY
ORGANIZATIONS TO ADVANCE
PROFESSIONAL CAREER DEVELOPMENT. Naik M, Kalaria S, Cintron N,
Ernest Mario School of Pharmacy–Rutgers, The State University of New Jersey,
is to assess student involvement in professional pharmacy organizations and
evaluate how students utilize different
opportunities from their involvement to
advance professional development and
career goals. These organizations play a
key role in developing initiatives to assist members in achieving professional
growth. As a result, this information can
be used by these organizations to target
specific student populations. Students
interested in specific career paths also
will be able to identify organizations that
ja p h a .org
may be the most useful to them.
will use anonymous paper and online
surveys to gather data from pharmacy
school students. It will be open to students of all years in a 0–6 doctor of pharmacy degree program as they are able to
join pharmacy organizations regardless
of their year. This population consists
of students from 2 pre-professional and
4 professional years. Surveys will include both quantitative and qualitative
questions regarding students’ intended
career goals and experiences with organization involvement. Questions
include identification of which organizations students are involved, extent of
involvement within the organization,
chapter versus national involvement,
rating of quality of professional development, reasons for involvement, and relevancy of organization-held events, all
with respect to predefined career goals
(e.g., community, hospital staff, industry). A free text option will be included
as well for career goals, which will then
be further analyzed and categorized by
similarity. Survey questions will consist
of questions in the following formats:
multiple choice, 5- and 10-point Likert
scales, and open-ended responses. The
collected data will be evaluated to assess
student involvement and the level of career-oriented professional development
offered to them. Descriptive statistics
and subgroup comparisons will be used
to analyze the data.
Results: Research in progress. Survey has been created and data collection
is currently underway.
Public Health
309—IMPACT OF A FOOD AND
DRUG ADMINISTRATION DRUG
SAFETY COMMUNICATION ON
ZOLPIDEM DOSING: AN OBSERVATIONAL RETROSPECTIVE COHORT. Harward J, Clinard V, Muzyk
A, Campbell University College of Pharmacy and Health Sciences, Lingerfeldt B,
Kerr Drug, E-mail: jonathanharward@
gmail.com
Objective: Previous studies have
been performed to analyze the effects of
Food and Drug Administration (FDA)
APhA2014 ABSTRACTS
communications and health warnings
on the health care system. However, no
trials are published to date that have
studied the effect of the FDA communication with regard to zolpidem-containing products. The primary objective of
this study is to compare proportions of
new prescriptions for select zolpidemcontaining products concordant with
FDA-approved dosing in women before
and after the original FDA drug safety
communication in January 2013. The
secondary objectives include describing
concordance proportion based on location (urban or rural) and prescriber (midlevel or MD) after the FDA drug safety
communication.
will include women aged 18 to 64 years
who were dispensed a new prescription
for select zolpidem-containing products
in a regional community pharmacy chain
from April 1, 2012 to September 30, 2012,
and from April 1, 2013 to September 30,
2013. Description of the secondary endpoints will serve as a demographic assessment of concordance based on the
type of provider prescribing the medication in question and the location where
the medication was dispensed. Patient
age, drug dispensed, dose of drug, city
or town in which drug was dispensed,
and provider type will be obtained from
a central pharmacy database. The primary objective will be analyzed using a
chi-square test.
Results: This study is pending institutional review board approval.
310—AN ASSESSMENT OF EDUCATION ON SECONDHAND SMOKE:
ARE PATIENTS GETTING ENOUGH
INFORMATION?. Squires S, Harding
University, E-mail: ssquires@harding.
edu
was to assess the knowledge of people
attending a local, community festival
regarding the dangers and consequences
of secondhand smoke.
Methods: A booth was set up at a
free, local, environmentally and health
conscious festival to distribute materials and educate attendees on the dangers of secondhand smoke. Attendees
approached the booth and were asked
to take a voluntary, anonymous survey
to assess their knowledge of the harms
caused by secondhand smoke. Once the
survey was completed, the attendees
were informed of the correct answers to
help increase their working knowledge.
Pamphlets, for those who prefer reading
materials, and a QR code which linked
to a YouTube video created for this project, for audiovisual learners, also were
distributed. The data collected from the
surveys included age group, race, smoking status, whether anyone in the home
smoked, and a variety of true/false and
multiple-choice questions.
Results: This population appeared
to be representative of the area in which
the study was conducted. The majority of those surveyed knew secondhand
smoke was harmful even if it could not
be smelled and that secondhand smoke
begins to affect a healthy, nonsmoker
almost immediately; however, nearly
one-third of the people surveyed believed airing out a room helped to avoid
exposure to secondhand smoke. Furthermore, only approximately 7% of those
surveyed knew that “heart attacks” was
the correct answer when asked which
disease or illness dropped in incidence
soon after smoking was banned in many
bars and restaurants.
Conclusion: The assessed education
of the population could be improved regarding the link between smoking or secondhand smoke and cardiac health. Improved education about these dangers
and consequences could be achieved
through more substantial interaction
with patients in many pharmacy settings, such as ambulatory care, retail,
and health fairs.
311—DEVELOPMENT OF A PHARMACIST-DRIVEN COMMUNITYBASED INITIATIVE TO REDUCE
CERVICAL CANCER RATES IN A
SMALL RURAL AREA: MEETING
THE NEEDS OF AN UNDERSERVED
POPULATION. Smith J, Story R, Jones
E, Khan P, Underwood B, Jang S, Kissack
J, Yates K, Harding University College
of Pharmacy, E-mail: jsmith17@harding.
edu
Objective: Despite the availability of human papillomavirus (HPV) vac-
j apha.org
cines, the incidence of cervical cancer in
this rural, medically underserved area
remains strikingly higher than the national incidence. The HPV Awareness
and Vaccination Project strives to meet
the needs of this population by developing educational tools to supplement
current resources offered by local health
officials. The overarching goal of this
multi-staged, interdisciplinary project is
to improve consumer knowledge about
HPV-related disease and to increase vaccination rates.
Methods: In 2009, student pharmacists under faculty supervision designed a survey for community leaders
and health care providers to better understand perceptions of current clinical
practice and behaviors of local patients/
residents. Another survey was subsequently developed targeting male patients; it was aimed at finding discrepancies in HPV knowledge. Next, the project
expanded community awareness of
HPV-related cervical cancer and genital
warts; various outlets were used such
as radio and print media, face-to-face
administration of surveys, continuing
education opportunities for pharmacists,
and live presentations to undergraduate
students. The progress of this initiative
has been regularly reported to the medical community via poster presentations
at state and national professional meetings.
study surveys reveal a clear lack of
knowledge regarding HPV and cervical
cancer. The project has since tailored its
educational initiative to provide meaningful and relevant information to the
public. From the study results, it can be
inferred that providing education will
increase the vaccination rate, thus lowering the rate of HPV-associated cancer.
The next phase of the program will incorporate new media outlets, such as television public service announcements.
The final phase will be administration
of HPV vaccine by student pharmacists and student physician assistants in
conjunction with the Local Health Unit
(LHU). This collaboration will continue
to strengthen as the research team works
directly with the LHU to coordinate and
implement the interdisciplinary HPV
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APhA2014 ABSTRACTS
vaccination days.
among fourth grade students.
312—IMPACT OF A TOBACCO PREVENTION PRESENTATION ON ELEMENTARY SCHOOL STUDENTS.
Prudencio J, Savona N, Batz F, University of Hawaii at Hilo, The Daniel K.
Inouye College of Pharmacy, E-mail:
[email protected]
Objective: The objective of this program is to prevent tobacco use in order
to improve community health and lessen
the economic burden, prior to initiation
of use.
Methods: In March 2012, a grant was
awarded to an organization to develop
and administer a 1-hour tobacco prevention education presentation, titled What
About Tobacco, for fourth-grade students. The organization trained student
pharmacists from a university to deliver
the tobacco prevention education programs. During fall 2012, these student
pharmacists delivered presentations to
approximately 650 fourth graders. The
program included: (1) screening of a
brief, professionally produced tobacco
prevention video designed for elementary school students; (2) an audience participatory activity discussing the effects
of tobacco use on various body organs;
and (3) a second audience participatory
activity discussing the toxic chemicals
found in tobacco products. Identical preand post-presentation quizzes, made up
of 6 true-or-false questions and 4 multiple-choice questions, were administered
to participants to assess the impact of the
presentations on their knowledge and attitudes toward tobacco use.
Results: After all of the presentations were completed, a total of 648 prequizzes and 649 post-quizzes were compiled and analyzed. Correct responses
for 9 of the 10 questions increased from
the pre-quiz to the post-quiz.
Conclusion: The analysis of the quiz
results and the overwhelmingly supportive feedback from the teachers of
the participating students indicates the
tremendous value of the What About
Tobacco program. It is apparent that the
What About Tobacco program is effective in increasing students’ knowledge
on the harmful effects of tobacco, and
should continue to be implemented
313—POINT
OF
DISPENSING
DRILL: PREPARING STUDENT
PHARMACISTS TODAY FOR THE
EMERGENCY
PREPAREDNESS
AND RESPONSE WORKFORCE OF
TOMORROW. Hogue G, Bounds R,
Barbye E, Taylor D, Truong H, University of Maryland Eastern Shore School of
study are to: (1) provide student pharmacists with the concepts and applications of emergency preparedness and
response; and (2) demonstrate the pharmacist’s role in mitigating public health
threats to the community, including
school, university, and health department.
Methods: Students received a 1-hour
instruction on emergency preparedness and response with emphasis on the
Strategic National Stockpile process of
delivering medications, vaccinations,
and supplies from federal stockpiles to
local points of dispensing (PODs) and a
30-minute quasi just-in-time-training on
drill day to explain the concepts and operations of PODs in a hypothetical terrorist release of anthrax over the East Coast.
Faculty members of the Maryland Board
of Pharmacy Emergency Preparedness Task Force (EPTF) and previously
trained students were utilized as leaders and facilitators to guide and monitor
drill operations. University crisis team
and local health department participated. Through-put times, accuracy rates,
and an after-action review, including
students’ survey, were evaluated.
Results: Approximately 100 first
professional year students, including 60
in pharmacy and 40 in physician assistant programs, participated along with
EPTF members, physician assistant faculty, student facilitators, campus police
officers, and health department personnel. Students alternated roles as patients
and providers. This POD drill resulted in
through-put rate of approximately 384
patients/hour with a gross error rate of
25%. Ninety-three percent of students
surveyed thought that the exercise was
of valuable and should be continued.
After-action reviews were positive for
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procedures but identified some processes for improvement.
Conclusion: Properly trained students can become volunteers for the
emergency preparedness and response
workforce in POD operations during
a public health crisis. This type of drill
could be expanded to other professional
programs and provide actual influenza
vaccinations to serve the dual purpose
of training and providing an essential
service. Prepared students gain a greater
awareness and become more inclined to
volunteer in their community.
314—THE PREVALENCE OF HYPERTENSION IN AN UNDERSERVED
POPULATION: A RETROSPECTIVE
STUDY COMPARING HEALTH
STATUS DATA FROM A SUBSET
POPULATION TO THE NATIONAL
HEALTH
AND
NUTRITIONAL
EXAMINATION SURVEY DATA.
Bangura S, Lassila H, Mattei T, Kroh T,
Duquesne University, E-mail: tkroh@
duqrx.org
Objective: This project aims to describe the prevalence of hypertension
and other risk factors from an underserved population in the surrounding
areas of Pittsburgh, Pennsylvania, and
comparing the data with the national
averages using the National Health
and Nutrition Examination Survey
(NHANES) data. The Affordable Care
Act created a focus on preventive health
services and a National Prevention
Strategy. Pharmacists are the most accessible, frontline health care providers
and are able to optimize patient health
through screening and prevention. The
National Prevention Strategy encourages the use of clinical and community
preventative services in an effort to prevent death and disability from preventable diseases and by detecting health
problems early. The strategy focuses on
improving cardiovascular health utilizing “highest value services that are both
evidence-based and cost effective including aspirin, blood pressure control, cholesterol reduction, and smoking cessation.” NHANES identified that a majority of Americans with high cholesterol or
blood pressure do not have it controlled.
Based on a literature search, there
APhA2014 ABSTRACTS
has not been a study conducted in a community pharmacy setting that compares
local area health screening statistics with
the NHANES data.
Methods: The Center for Pharmacy
Services provides community-based
pharmaceutical care and wellness services including a preventative care
program through community health
screenings. The pharmacy’s preventative care outreach program aligns with
the National Prevention Strategy in an
effort to prevent death and disability
from preventable diseases and by detecting health problems early. This past fiscal year, 2,035 health screenings reaching
1,004 individual patients was completed.
Data collected from these health screenings will be analyzed using descriptive
statistics and compared with the national
averages based on NHANES data.
315—REFERRAL OF PATIENTS TO
COMMUNITY-BASED HEALTH RESOURCES: EXPERIENCES OF COMMUNITY PHARMACY EMPLOYEES
AND PATIENTS. Helsel N, Purdue
University College of Pharmacy, Frail C,
University of Minnesota College of Pharmacy, Snyder M, Purdue University College of Pharmacy, E-mail: snyderme@
purdue.edu
study is to describe community pharmacist, technician, and patient perceptions
and experiences regarding patient referrals to community-based health resources as a means of health promotion.
Methods: Rx-SafeNet is a community pharmacy practice-based research
network administered by the Purdue
University College of Pharmacy’s Center for Medication Safety Advancement.
Study participants will be identified at
the investigators’ visits to Rx-SafeNet
pharmacies that have expressed interest
in this study. Eligible participants must
be ≥18 years of age; be a pharmacist,
technician, or patient of the pharmacy;
and give consent to participate. Semistructured interviews will be conducted,
either face-to-face or over the phone, per
the participant’s preference and availability. Interviews will gather information about participant experiences and
opinions pertaining to the roles of community pharmacists and technicians in
referring patients to community-based
health resources. Community-based
health resources refer to any source of assistance or information that could impact
health and is located outside the pharmacy, but within the community. Semistructured interviews will enable further
probing regarding referrals being made.
Interviews will be audio-recorded and
transcribed verbatim by a professional
transcriptionist. Each participant will
be offered a $25 gift card as compensation. Transcripts will be analyzed using
qualitative thematic analysis supported
by MaxQDA v. 10 software. Themes will
be identified for each pharmacy site and
summarized across sites.
date, 1 site visit has been completed, and
13 participants have been interviewed.
Site visits will continue throughout the
coming months.
Quality and Safety
316—ADVERSE REACTIONS AND
CISPLATIN EXCRETION IN URINE
OF PATIENTS WITH HEAD AND
NECK CANCER UNDERGOING
CHEMOTHERAPY. Visacri M, Faculty
of Medical Sciences, Unicamp, Pincinato
E, Mackenzie Presbyterian University,
Ferrari G, Souza C, Lourenço A, Faculty
of Medical Sciences, Unicamp, Pimentel
R, Biology Institute, Unicamp, Tuan B,
Ambrosio R, Faculty of Medical Sciences, Unicamp, Mazzola P, pmazzola@fcm.
unicamp.br, Clinical Pathology Lima,
Co-Author, Faculty of Medical Sciences,
Unicamp Clinical Medicine, Patricia,
[email protected] Faculty of
Medical Sciences, Unicamp,
Objective: This study was designed
to investigate the adverse reactions in
patients with head and neck cancer undergoing chemotherapy and to study the
urinary excretion of cisplatin.
Methods: This was a prospective
study conducted from May 2011 to January 2013 in Brazil. Outpatients with head
and neck cancer received a first course of
cisplatin chemotherapy (80 or 100 mg/
m2) as therapy. Adverse reactions were
classified based on severity (Common
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Toxicity Criteria v.4.0). Cisplatin excretion in urine was evaluated by highperformance liquid chromatography in
3 periods: 0–12, 12–24, and 24–48 hours
after administration of cisplatin. Results
were statistically analyzed.
Results: Fifty-nine patients were
analyzed (group 100 [100 mg/m2]: n =
41; group 80 [80 mg/m2]: n = 18). Their
mean age was 55.6 ± 9.4 years, most were
male, white, accentuated smokers and
drinkers, and had pharyngeal tumors
in advanced stages. The most frequently
observed adverse reactions were anemia
(81.4%), lymphopenia (78.0%), nausea
(64.4%), and change in creatinine clearance (63.2%), with a prevalence of grades
1 and 2. Patients from both groups had
significant reductions in blood cell
counts and creatinine clearance, with no
difference between the groups in these
parameters. However, the increase in
serum creatinine was significant only
for group 100. Regarding severity of reactions studied, only vomiting was statistically more severe in group 100. The
amount of cisplatin excreted at 0–12, 12–
24, and 24–48 hours in groups 100 and 80
was, respectively, 6.7 ± 5.3 and 7.7 ± 8.5,
0.7 ± 0.6 and 0.8 ± 0.6, and 0.5 ± 0.3 and
0.5 ± 0.3 ng of cisplatin/mg creatinine.
There was no difference between groups
and the amount of excreted cisplatin did
not influence the severity of adverse reactions.
Conclusion: The period of highest
cisplatin excretion was 0–12 hours after
chemotherapy, the dose of chemotherapy did not influence the severity of adverse reactions (except for vomiting and
creatinine) or the amount of cisplatin excreted, and the cisplatin excretion could
not predict toxicity.
317—ATTITUDES OF ARIZONA
COMMUNITY PHARMACISTS ON
THE MONITORING AND TRACKING OF MEDICATION ERRORS
AND NEAR MISSES. Augustine J,
Warholak T, University of Arizona,
MacKinnon N, University of Cincinnati,
is to examine the attitudes and current
behaviors of community pharmacists in
Arizona about the tracking and monitorMA R /APR 2014 | 54:2 |
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APhA2014 ABSTRACTS
ing of medication errors or quality-related events (QRE) in their primary work
location.
surveyed members of the Arizona Pharmacy Association who indicated community pharmacy as their primary practice site. The survey was revised from a
previously published instrument used
in Nova Scotia, Canada. Two-thirds of
the study population received the questionnaire that asked about QRE, which
includes medication errors and near
misses. The remainder received a similar
questionnaire about medication errors
that used the language from the new Arizona legislation, which does not include
near misses. Questionnaire reliability,
validity, and scale and item functioning
will be assessed using the Rasch rating
scale model. In situations where data fit
the model, ordinal data will be converted
to interval level data; t tests will be completed to compare the Rasch scores on
the items that are the same on both surveys. An alpha = 0.05 has been selected
a priori. This study was approved by the
university institutional review board.
Results: Research in progress. Fifty
pharmacists returned usable QRE questionnaires (response rate = 19.8%) and
35 pharmacists returned usable medication errors questionnaires (response
rate = 31.8%). In both groups, the most
frequent respondents were pharmacy
managers (47% and 40%, respectively),
who worked full time (79% and 74%) in
a supermarket (42% and 37%). In both
groups, the vast majority of respondents
indicated that their pharmacies have a
current process for reporting errors (96%
and 97%). No differences were found in
demographic information (i.e., job title,
sex, number of hours worked per week,
pharmacy type, pharmacy location,
number of years practiced, and number
of prescriptions processed per week) of
respondents (P>0.05). Additional analysis will be conducted to allow for comparisons.
318—CEFTRIAXONE SAFETY IN
THE PEDIATRIC POPULATION. Rumore M, Sussman R, Cohen Children’s
Medical Center, E-mail: mrumore@nshs.
edu
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study is to evaluate clinical decisions in
the face of a cluster of ceftriaxone immediate hypersensitivity reactions in a pediatric population.
Methods: Adverse drug reactions
(ADRs) to ceftriaxone from the medical
center’s computerized reporting system were evaluated using chart review
from January 2012 through September
2013 (October through December 2013
data will be added to the final results to
provide 2 years of data). Causality was
assessed using the Naranjo ADR Probability Scale. This study included conducting a literature review, distributing
a Pediatric Medication Alert, reporting
to MedWatch, and changing the administration policy.
Results: Research in progress. Over
22 months, ceftriaxone was responsible
for more ADRs than any other medication, specifically 18% (16/89); 13.5%
(12/89) involved itching, swelling, periorbital edema, hives, rash or respiratory
depression. Four anaphylactic reactions,
severe in nature requiring intervention
to sustain life and subsequent hospitalization, 3 of which involved cardiac arrest occurred. Two patients had sickle
cell disease but hemolytic anemia was
ruled out. No patient had documented
previous allergies to ceftriaxone. No
case involved neonates. Hypersensitivity could not be tested by skin testing
or ceftriaxone-specific IgE, nor were
rechallenges undertaken. Anaphylaxis
reactions are rare (0.0001%–0.1%) but the
rate is much higher than penicillin. The
literature review revealed a number of
published anaphylaxis cases with ceftriaxone after a single dose. Although there
was not a denominator for total ceftriaxone doses, the ADR volume indicates
pediatric patients are at increased risk
for ADRs from ceftriaxone. Switching
to cefotaxime as a preferred agent was
explored but decided against because
of multiple daily dosing requirement.
Safety improvement efforts included
joint pharmacy and nursing education,
a Pediatric Medication Alert, restriction
to Food and Drug Administration–approved indications or infections that
could not be treated with oral agents,
and administration over approximately
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30 minutes. Extreme caution is exercised
with ceftriaxone in pediatric patients
with sickle cell anemia or patients with
previous type 1 hypersensitivity to penicillin/cephalosporins.
319—DESCRIPTION AND COMPARISON OF DRUG DIVERSION
IN PHARMACIES BY PHARMACISTS, INTERNS, AND PHARMACY
TECHNICIANS. Draime J, Cedarville
University, Anderson T, McBride Orthopedic Hospital, Anderson D, Cedarville
University School of Pharmacy, E-mail:
[email protected]
is to describe reported drug diversion
within the practice of pharmacy.
Methods: There is limited research
that examines the nature and extent of
drug diversion within the practice of
pharmacy. If drug diversion is reported,
state boards of pharmacy examine cases
involving registered pharmacy personnel. To describe the problem of diversion, a sample of state board records
were examined. First, states were classified, using U.S. Census classifications,
into regions and divisions to provide a
representative sample. States that did
not have minutes posted online or that
did not register technicians were excluded. If more than 1 state remained in a
division, then a state was randomly chosen for analysis. Meeting minutes were
obtained from May 2008 to May 2013.
The following items were obtained for
each case of drug diversion: (1) category
of pharmacy employee (pharmacist,
technician, intern), (2) type of substance
(controlled, non-controlled, both); (3) use
of diverted substance (sale, personal use,
both, unknown); and (4) action taken by
the board. An a priori sample size was
calculated (alpha = 0.05, effect size = 0.3,
n = 253 cases). Descriptive statistics were
performed for all data in SPSS v.21, and
chi-square tests were used to assess categorical differences.
Results: A total of 811 drug diversion cases in 9 states were identified and
used. Most cases were involving a pharmacy technician (71.4%), controlled substances only (94.2%), diverted for personal use (46.6%), and resulted in license
revocation/surrendering (62.5%). When
APhA2014 ABSTRACTS
examining drug diversion use by type of
substance, there were significant differences by pharmacy employee type (sale
use P = 0.003; personal use P = 0.032; unknown use P<0.001).
Conclusion: Drug diversion is prevalent, as indicated by the 811 cases examined by state boards, and many cases
may be unreported. Technicians represent nearly three-fourths of diversions. It
is essential that the practice of pharmacy
identifies and assesses strategies to reduce drug diversion.
320—DETERMINING RATES OF
INAPPROPRIATE
MEDICATION
DOSING FOR PATIENTS WITH RENAL DYSFUNCTION IN AN OUTPATIENT SETTING. Hovis Z, Breslow R,
University of Wisconsin School of Pharmacy, Statz-Paynter J, Lisowe K, Dean
Clinic, E-mail: [email protected]
is to quantify the rates of dosing errors
for medications requiring dose adjustment based upon renal function estimates at the time of prescribing in the
outpatient setting.
Methods: In this retrospective study,
electronic medical records from an outpatient health system will be reviewed
and analyzed. Patients are required to
be ≥18 years of age and must have been
prescribed a medication requiring dose
adjustment for renal function between
September 1, 2012 and August 31, 2013
for inclusion. A medication list will be
finalized based upon frequency of use,
clinical relevance, as well as previous
literature examining similar outcomes
in the outpatient setting. An estimated
creatinine clearance will be calculated
using the Cockcroft-Gault equation with
lab values from the date the prescription
was written or the closest date prior. The
prescribed dose of the target medications will be assessed for appropriateness based on the calculated creatinine
clearance for each patient. The incidence
of inappropriate dosing will be reported
for each medication individually and
in aggregate by dividing instances of
inappropriate dosing by total instances
requiring dose adjustment. Descriptive
statistics will be used to describe population demographics.
Results: Research in progress. Current error rates in this setting are unknown. The results of this research will
help inform decision makers on the necessity of process improvement efforts
to reduce dosing error rates in this population to ultimately decrease emergent
health care expenditures from resultant
adverse drug events.
321—EFFECT OF LORAZEPAM VERSUS MORPHINE ON QUALITY OF
LIFE IN HOSPICE PATIENTS WITH
DYSPNEA AND ANXIETY. Daubert
E, Bolesta S, Wilkes University, E-mail:
[email protected]
Objective: The field of palliative care
aims to ease the suffering of terminally
ill patients. However, there is little literature that addresses how to best improve
quality of life of palliative care patients
with the “symptom cluster” of anxiety
and dyspnea. The purpose of this study
is to determine whether treatment with
benzodiazepine or opiate therapy has a
greater impact on improving the quality
of life in terminally ill patients who are
enrolled in a hospice service.
randomized, double-blind, clinical trial.
Patients ≥18 years of age enrolled in a
hospice service, diagnosed with anxiety
and dyspnea, and able to take oral medications will be eligible. Patients with a
life expectancy of ≤7 days or contraindications to the study drugs will be excluded. Subjects will be randomly assigned
to receive either lorazepam or morphine.
Those in the morphine group will receive
5 mg oral morphine. The lorazepam
group will be treated with 0.5 mg oral
lorazepam. Additional doses will be provided every 30 minutes until anxiety and
dyspnea intensity is decreased by at least
50%. Symptom relief will be evaluated
using the Edmonton Symptom Assessment Scale. Patients will receive treatment for 14 days. The primary outcome
will be the change in patients’ perception
of their quality of life. This will be assessed using the Functional Assessment
of Chronic Illness Therapy–Palliative
Care scale, which patients will complete
prior to initiation of therapy and after 7
and 14 days of treatment. An intentionto-treat analysis will be performed and
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the change in quality of life observed will
be compared between groups using a
multivariable logistic regression analysis
to adjust for confounding variables.
Results: Research in progress. Results are pending study completion.
322—EVALUATING HEALTH CARE
PROFESSIONALS’ PERCEPTIONS
REGARDING INADVERTENT DISPENSING OF DISCONTINUED
MEDICATIONS. Fisher K, Djuric
Kachlic M, Chan Marcelo J, University of
Illinois at Chicago, E-mail: jchan16@uic.
edu
this study is to identify health care professionals’ perceptions of their responsibilities associated with dispensing of
discontinued medications. Secondary
objectives are to evaluate the misconceptions regarding use of electronic medical records and to assess the perception
of health care professionals on patient
awareness of discontinued medication.
Methods: This is a prospective, survey-based study. The survey will assess
participants’ perceptions, knowledge,
and understanding of discontinuing
medications and e-prescribing. Participants will include prescribers and
pharmacists practicing within the health
system. Potential study participants will
be recruited through e-mail blasts sent to
health care professionals on the health
system’s listserves. The e-mail blast will
include a link to the survey with a brief
description of the study objectives. The
survey engine, Qualtrics, will be utilized
to collect responses. The survey will be
piloted before initiation of e-mail recruitment. The survey will be sent to participants at the beginning of week 1 with a
deadline of 8 weeks to respond. Weekly
reminder e-mails will then be sent for the
first month and biweekly for the second
month. The survey will capture basic
demographic information about each
participant and responses will remain
anonymous. Survey questions will be
primarily formatted using a Likert scale.
Data collection will be completed within
2 months from start date and data analysis will occur thereafter. The information
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APhA2014 ABSTRACTS
ued medications and e-prescribing.
to be collected December through February.
OF INTERDISCIPLINARY TEAMWORK ON MEDICATION SAFETY
IN AN ETHIOPIAN EMERGENCY
DEPARTMENT. Aboneh E, Chui M,
University
of
Wisconsin–Madison
School of Pharmacy, E-mail: aboneh@
wisc.edu
is to explore factors that impact medication safety resulting from deficiencies in interdisciplinary teamwork in a
resource-limited emergency department
(ED) in a developing country.
Methods: A cross-sectional qualitative study design was employed at an
academic ED in Ethiopia. Direct, nonparticipant observations and semi-structured interviews were conducted with 4
nurses, 2 pharmacists, and 2 physicians.
Field notes and transcribed interviews
were subjected to thematic analysis using the System Engineering Initiative for
Patient Safety as a guiding framework.
Results: Consistent with hazards
identified in EDs in the United States,
this study found poor interdisciplinary
teamwork as a potential contributor to
medication errors in the ED. Physicians,
nurses, and pharmacists cited numerous work system contributors including
organizational factors such as power
gradients, lack of training, regular staffing turnover, and lack of clearly defined
policies. The physical environment, in
addition to being noisy, crowded, and
cluttered, also was not designed to provide clues to the health care providers
and facilitate coordinated care for acute
needs of incoming patients. While the
ED had access to technology such as
electrocardiographs and portable ultrasound machines, these devices were old
models and frequently not functional.
Conclusion: Significant research
has been conducted in EDs in the United
States to identify and mitigate patient
safety hazards, but interventions have
been conducted in resource-intensive
academic health centers with significant technology resources. The limited
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resources and training available in EDs
from developing countries means that
the issue becomes even more important.
In order to recommend and test redesign
efforts aimed at reducing medication errors in low-resource EDs, it is important
to understand this context for interventions to be successful. Specifically, because problems were identified with
interdisciplinary teamwork, an area of
focus for future research can be to determine how the ED pharmacist can better
support the team to improve medication
safety.
324—EVALUATION OF MEDICATION ERRORS VIA A RETURN-TOSTOCK AUDIT IN A COMMUNITY
PHARMACY SETTING. Krinsky D,
Elavsky M, Dahmen N, Northeast Ohio
Medical University, E-mail: dkrinsky@
neomed.edu
study are to: (1) assess the incidence of
errors in prescriptions being returned to
stock; (2) identify possible trends; and (3)
determine potential action steps to correct these errors.
Methods: The community pharmacy studied receives a daily printout
listing prescriptions filled 10 days prior
that had not been picked up by the patient. These prescriptions are credit returned, then returned to stock. Because
these prescriptions have already been
verified by a pharmacist and are ready to
dispense, they are ideal for auditing for
potential errors. Approximately once every 2 weeks ≥6 of these prescriptions are
audited by second- or third-year student
pharmacists who are on an introductory
pharmacy practice experience rotation
at this community pharmacy. The following elements are reviewed for accuracy and compared with the original
prescription: patient name, drug name,
dose, quantity, strength, dosage form,
package size, directions, number of refills, prescriber, and bottle cap.
Results: A total of 693 prescriptions
were reviewed for possible errors from
January 1, 2011 to October 1, 2013. Of
these prescriptions, 570 were for an oral
medication (82.3%), 73 were for a topical product (10.5%), and 50 were for an
inhaled medication (7.2%). Twenty-six
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errors were found for an error rate of
3.75%. The types of errors included:
quantity (17), directions (4), and 1 each
for physician name, number of refills,
dosage form, missing Drug Enforcement
Administration number on the original
prescription, and safety cap.
Conclusion: This audit has provided
the pharmacy staff with valuable data to
improve the dispensing processes and
staff communication. These data are
discussed at the quarterly Continuous
Quality Improvement meetings and reemphasize to all staff (i.e., pharmacists,
technicians, and student pharmacists)
the importance of double checks and accuracy over speed. Data collection will
continue on a regular basis and staff will
continue to find ways to perform tasks
more effectively and improve accuracy.
325—EVALUATION OF THE NUMBER AND TYPE OF POTENTIAL INTERACTIONS FOUND BETWEEN
PRESCRIPTION AND OVER-THECOUNTER MEDICATIONS AT A
COMMUNITY PHARMACY. Almada
E, Fernandez C, Dorame M, Dominguez
C, University of Arizona, E-mail: [email protected]
is to explore the frequency and severity
of potential over-the-counter (OTC) and
prescription medication interactions
among patients at a chain pharmacy location in Oro Valley, Arizona.
Methods: A questionnaire was created listing 7 categories of the most
common OTC medications and comorbidities among patients. Questionnaires
(n = 1,200) were distributed in patient’s
prescription bags from January 14 to
March 29, 2013. Patients were notified
about the project by pharmacy staff and
asked to mark the OTC items they used,
the comorbidities they have, and then return the questionnaire to the pharmacy.
Upon return, a pharmacist used the compendium Clinical Pharmacology to review
the questionnaire against the patient’s
prescription profile to identify and classify the number, type, and severity of interactions found. Categories of severity
were contraindicated, severe, moderate,
major, and low. Once an interaction was
found, patients were notified by phone
APhA2014 ABSTRACTS
call or counseled at the pick-up window.
Chi-square with an alpha priori set at
0.05 was used to assess whether having
≥3 comorbidities increases the likelihood
of an interaction.
Results: A total of 67 questionnaires
were returned to the pharmacy. Of the
67 questionnaires, 86 drug interactions
were identified: 41 moderate, 7 major,
5 severe, 4 low, and 1 contraindicated.
Pain medications accounted for a higher
percentage of drug interactions compared with other categories (23.3%).
While 46.3% of patients had ≥3 comorbidities, this relationship did not increase the probability that these patients
would experience more drug interactions compared with those with either <3
or no morbidities (chi-square = 0.372, P
= 0.542).
Conclusion: Although the amount
of interactions found was low, it would
be beneficial for community pharmacies
to have information about a patient’s
OTC and herbal supplement use to help
prevent major interactions that can affect
drug therapy and a patient’s quality of
life.
326—IDENTIFYING
WHETHER
A DISCUSSION IS NEEDED ON
GENERIC-TO-GENERIC SWITCHING OF NARROW THERAPEUTIC
INDEX DRUGS: A LITERATURE REVIEW. Nguyen Diep J, Shah M, Toscani
M, Rutgers University, E-mail: jonathan.
[email protected]
Objective: An informal survey of the
literature revealed that while the various
controversies surrounding brand-to-generic switching (e.g., integrity of current
bioequivalence criteria, clinical impact)
are often discussed, it is difficult to find
mention of the same controversies as
they relate to generic-to-generic substitution for narrow therapeutic index (NTI)
drugs. The purpose of this review is to
assess the literature for commentary,
guidance, surveys, or clinical trials related to generic-to-generic substitution
of NTI drugs and the potential clinical,
social, and economic impacts of making
such a substitution. Current bioequivalence guidelines as they relate to this particular category of medications also will
be reviewed and discussed.
Methods: A list of NTI drug classes
for which the literature search is to be
conducted will be defined. The website
of the Food and Drug Administration
(FDA) will be consulted, along with other relevant FDA publications and guidances. English-language publications
will be searched in Medline to retrieve
references that relate to generic-to-generic substitution for this list of medication
classes.
list of NTI drug classes was defined to
include the following: antiarrhythmic,
antiepileptic, anticoagulant, hormone
replacement, immunosuppressive, and
oral contraceptive medications. The current accepted ranges for bioequivalence
between brand and generic products
are 80% to 125% for non-NTI medications and 95% to 105% for NTI medications. Two relevant publications have
been identified thus far. The first of
these, a survey, saw 88% of physicians
concerned about breakthrough seizures
with a formulation switch. The second
publication saw a possible link between
levothyroxine adverse event reporting
and switching of the generic manufacturer of this drug.
PHARMACIST TOOLKIT ON HIGHRISK MEDICATION USE IN THE
ELDERLY. Pendley M, University of
Kentucky, Nau D, Pharmacy Quality
Alliance, Freeman P, University of Kentucky, Hanna C, American Pharmacy
Services Corporation, Divine H, University of Kentucky, E-mail: [email protected]
Objective: Specific quality measures
on medication use have been developed
by the Pharmacy Quality Alliance (PQA)
and adopted by the Centers for Medicare and Medicaid Services (CMS) to
rate Medicare Part D prescription drug
plans, including a metric specific to reducing the use of high-risk medications
(HRMs) in elderly adults. Community
pharmacists are uniquely positioned to
improve this quality measure through
their regular communications with prescribers and patients. Providing targeted
educational resources to assist the pharmacist with HRM-related interventions
j apha.org
may impact pharmacy performance. The
objectives of this study are to: (1) develop
and evaluate the impact of an educational resource for pharmacists designed to
reduce use of HRMs; and (2) evaluate the
outcome of toolkit utilization on HRM
usage and pharmacy performance on the
HRM quality measure.
Methods: Pharmacy shareholders of
an independent pharmacy cooperative
will be invited to participate. Pharmacists will receive a live education session
about the PQA quality measures, HRMs,
and potential alternatives to HRMs. Additionally, a toolkit will be provided with
resources (e.g., template presentations,
handouts, fax cover letters, brochures)
to assist in presenting information to
both prescribers and patients in their
communities about HRMs and their alternatives. Pharmacists will implement
resources over a 6-month period. A preand post-survey will be administered to
collect basic demographic information,
assess knowledge of HRMs and PQA
quality measures, and confidence in addressing HRM usage with prescribers
and patients. Additional questions to
evaluate the usefulness of the toolkit will
be included on the post-survey. Dispensing system records will be reviewed to
compare HRMs dispensed at baseline
and at the end of the 6-month intervention. Pharmacy performance scores at
baseline and after 6 months on the PQA
HRM-specific measure will be compared
using the Electronic Quality Improvement Platform for Plans and Pharmacies
(EQuIPP) platform.
328—IMPACT OF NAUSEA AND
VOMITING ON THE QUALITY OF
LIFE OF ONCOLOGY PATIENTS.
Souza C, Visacri M, Tuan B, Ferrari G,
Lourenço A, Mazzola P, Lima C, Moriel
P, Faculty of Medical Sciences, Unicamp,
Objective: This study was designed
to evaluate the impact of nausea and
vomiting on the quality of life (QOL) of
oncology patients.
Methods: This was a quantitative,
cross-sectional, descriptive study, in
which patients receiving chemotherapy
were asked about the occurrence of
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APhA2014 ABSTRACTS
nausea and vomiting at the moment of
infusion and/or after a chemotherapy
session, over the period of 1 year. The
severity of effects was classified according to Common Toxicity Criteria (CTCAE v. 4.0; Grades 1–4) and by a visual
analogue scale (VAS; range, 0–10). QOL
was measured using a validated questionnaire (FACT-G, v. 4.0) with 4 fields:
physical well-being, social/family, emotional, and functional, the first 3 with
scores of 0–28 and the last with scores of
0–24. Statistical analysis of the data was
performed using Spearman’s correlation
(P<0.05).
Results: Fifty patients were studied (58.2 ± 10.8 years of age, 54.0% men,
and 72.0% with gastrointestinal cancer).
Nausea was the most common adverse
event (31; 62.0%), with grade 1 toxicity most prevalent (12; 24.0%). On VAS,
nausea obtained an average of 4.4 (range,
2–9). Sixteen patients (32.0%) reported
vomiting, mostly grade 1 (8; 16.0%), with
a mean score on VAS of 5.9 (range, 4–9).
The global QOL was given a score of 70.4
± 6.4 (range, 54–88). Patients with cancer
had reduced scores in the physical wellbeing (16.4 ± 4.2), social/family (20.3
± 2.8), emotional (16.2 ± 3.2), and functional (17.5 ± 2.7) fields. Spearman’s test
revealed a strong correlation between
the instruments (degree of toxicity and
VAS), showing that they had the same
ability to evaluate the adverse effects of
chemotherapy.
Conclusion: There was no correlation between nausea and vomiting and
QOL. Although there was a high prevalence of nausea and vomiting in chemotherapy, there were few severe symptoms, which may explain the lack of correlation with QOL.
329—THE INCIDENCE AND FINANCIAL IMPACT OF MEDICATIONS
DISPENSED DESPITE ELECTRONIC
MEDICAL RECORD DISCONTINUATION. Baranowski P, Peterson K,
Dean Clinic–Janesville East, Statz-Paynter J, Dean Health System, Zorek J, University of Wisconsin–Madison, E-mail:
[email protected]
Objective: The primary aim of this
study is to determine the incidence of
medications dispensed to patients with-
e196 JAPhA | 5 4:2 | M AR/AP R 2014
in a health care network of affiliated primary care clinics and community pharmacies despite electronic medical record
discontinuation by their health care providers. A secondary aim is to determine
the financial impact resulting from this
medication error.
Methods: In this retrospective cohort study, the electronic medical and
pharmacy records of patients who
receive care from this health care network will be reviewed to identify the
incidence of medications dispensed
despite discontinuation (MDDD) by
health care providers. Patients aged ≥18
years within the network who filled a
prescription medication from June 2012
to August 2013 will be included in the
study. A computer algorithm linked to
the electronic medical and pharmacy
records will identify all medications that
were dispensed during this period and
all medications that were electronically
discontinued by a health care provider.
These data points will be cross-referenced to identify MDDD and medications not dispensed following discontinuation (non-MDDD). Descriptive
statistics will be used to characterize data
and calculate the incidence of MDDD
and non-MDDD. Chi-square tests will be
used to compare the incidence of MDDD
with non-MDDD. All MDDD will be categorized by pharmacological classification to identify problematic medication
categories for future interventions. The
wholesale acquisition cost will be applied to each MDDD to determine the
financial impact of this medication error.
Conclusion: There are no mechanisms currently in place within this
health care network to safeguard against
MDDD. By determining the incidence of
MDDD, identifying problematic medication categories, and calculating the financial impact of this medication error,
this study has the potential to inspire and
inform future interventions to reduce
MDDD, improve medication safety, and
positively impact patient care.
330—THE INFLUENCE OF COMMUNITY PHARMACISTS ON STAR
RATINGS: AN ANALYSIS OF FACTORS AFFECTING PERFORMANCE
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MEASURES. Culpepper B, University
of North Carolina at Chapel Hill Eshelman School of Pharmacy, Michaels N,
Petri D, Kerr Drug Inc., Ferreri S, Marciniak M, University of North Carolina at
Objective: As health care payment
models evolve from fee-for-service to
pay-for-performance, Medicare Part D
plans are being graded and provided a
star rating based on performance measures defined by the Pharmacy Quality Alliance (PQA). Plan reimbursement
from the Centers for Medicare and
Medicaid Services (CMS) is determined
by the star rating. Pharmacists have an
opportunity to affect performance measures such as medication adherence
and appropriate treatment for chronic
disease states. The purpose of this study
is to identify factors that may impact
achievement of performance measures
and, therefore, star ratings.
includes data obtained from Electronic
Quality Improvement Platform for Plans
and Pharmacies (EQuIPP), a PQA-developed platform that provides benchmarked performance data. The 4 performance measures included in this study
are: proportion of days covered (PDC)
for hypertension, diabetes, and cholesterol medications, and angiotensin-converting enzyme inhibitor/angiotensin
receptor blocker therapy in patients with
diabetes. May 2013 data from 76 stores
in a regional pharmacy chain will be
extracted from EQuIPP. The stores will
be ranked and given a star rating (from
CMS) for each performance measure.
A list of factors that may affect performance measure achievement has been
developed by the investigators. These
factors include: store setting, weekly
prescription volume, number of interns
employed, monthly hours of pharmacist
overlap, years of pharmacist experience,
pharmacist completion of a medication
therapy management certificate training
program, presence of residency-trained
pharmacists, number of patients enrolled in a medication synchronization
program, and percentage of comprehensive medication review claims. Data will
be analyzed to determine which factors
APhA2014 ABSTRACTS
may have contributed to the store’s ranking for each performance measure. The
probability of each store’s star rating as
determined by CMS will be predicted for
each variable separately using bivariate
logistic regression and then include all
variables simultaneously using multivariate logistic regression.
331—INTRAVENOUS ACETAMINOPHEN USAGE IN PEDIATRIC PATIENTS. Samide J, Rumore M, Cohen
Children’s Medical Center, E-mail: [email protected]
Objective: This study aimed to delineate appropriate usage and improve
safety of intravenous acetaminophen
(IVAPAP) in pediatric patients at a metropolitan children’s hospital.
Methods: This study was a retrospective medication use evaluation
(MUE) of IVAPAP usage for July and
August 2013. It restricted IVAPAP to 24
hours for febrile patients in whom oral/
rectal administration is not possible.
IVAPAP is available in 1000 mg (100 mL)
vials. The MUE was designed to examine
compliance with this institution’s IVAPAP guideline and to assess feasibility of
dispensing prefilled syringes.
Results: IVAPAP was ordered 78
times for 52 patients. On average, patients received 13 mg/kg/dose and dosages were weight-based appropriate.
The maximum daily dose of 2400 mg
was exceeded in 1 patient. Despite the
restriction, 55% (43/78) of orders were
for pain. Seventy-seven percent (40/52)
of patients receiving IVAPAP had documented NPO status and 42% of patients
received other oral medications close to
IVAPAP administration time. Approximately, 29% (23/52) of patients were on
both intravenous and oral acetaminophen concurrently. Although the current
policy states that order duration not exceed 24 hours, 15% were written for longer time periods. Analysis showed that
almost all doses given at this institution
require further drawing up on the floor.
Further analysis showed that patients on
average receive 1 dose, even when the
order is written for multiple doses, complicating implementation of individual
dose preparation.
Conclusion: Iatrogenic 10-fold dosing errors have occurred in pediatric
patients; the dose is calculated in mg but
may be erroneously given in mL. This, as
well as budgetary concerns, prompted
restriction of IVAPAP to antipyretic use;
conduct of an MUE to ensure its proper
use; and conduct of staff education. Preliminary results of this ongoing study
suggest that the policy is not being followed. In the future, there is planning to
revise the policy, conduct additional education, and adopt the Institute for Safe
Medication Practices recommendation
for preparation of patient-specific doses
in syringes.
332—LC-MS/MS METHOD DEVELOPMENT AND VALIDATION FOR
THE SIMULTANEOUS QUANTITATION OF VENLAFAXINE AND
ITS ACTIVE METABOLITE O-DESMETHYL VENLAFAXINE IN HUMAN K2-EDTA PLASMA. Dannana
G, Andhra University College of Pharmaceutical Sciences, India, E-mail: [email protected]
Objective: A highly sensitive, validated LC-MS/MS method with very
short run time was developed for the
simultaneous estimation of venlafaxine
and its active metabolite O-desmethyl
venlafaxine in human plasma by using
clozapine as internal standard.
Methods: The analytes and the internal standard were extracted from the
human plasma by protein precipitation
using methyl t-butyl ether. The analytes
and the internal standard were separated by high-performance liquid chromatography on a BDS Hypersil C8 column
(50 mm x 4.6 mm, 3 µm) using an isocratic mobile phase consisting of 5 mM ammonium acetate:acetonitrile:methanol in
the ratio 10:20:70 v/v at a flow rate of 1.0
mL/min. The retention times were 0.86
min, 1.5 min, and 1.6 min, for clozapine,
O-desmethyl venlafaxine, and venlafaxine respectively. The analytes were monitored by MS/MS in multiple reaction
monitoring mode via positive electron
spray ionization using the transitions
m/z 278.20 precursor ion to the m/z
58.20 product ion for venlafaxine, m/z
264.20 precursor ion to the m/z 58.10
product ion for O-desmethyl venlafaxine
j apha.org
and m/z 327.20 precursor ion to the m/z
270.10 product ion for clozapine.
Results: The developed method
was validated according to International Conference on Harmonisation
guidelines. The assay exhibited linear
dynamic range of 1.01–301.64 ng/mL for
venlafaxine and 1.36–407.39 ng/mL for
O-desmethyl venlafaxine. The average
absolute recoveries of venlafaxine and
O-desmethyl venlafaxine were >69.0% at
all concentration levels with acceptable
precision. Human plasma containing
quality control samples were checked for
freeze and thaw stability and they were
found to be stable for 4 cycles. A run time
of 2.5 min for each sample made it possible to analyze more than 300 human
plasma samples per day.
Conclusion: The validated method
can be successfully used for pharmacokinetic, bioavailability, and bioequivalence studies to analyze venlafaxine and
its major active metabolite O-desmethyl
venlafaxine in human plasma samples.
333—A LONGITUDINAL ANALYSIS
OF HIGH-RISK MEDICATION USE
AMONG BENEFICIARIES IN TWO
MEDICARE DRUG PLANS. Zhang Y,
Doucette W, Brown G, Pendergast J, University of Iowa, Frank J, OutcomesMTM,
study is to assess factors associated with
likelihood of filling high-risk medications (HRM) for beneficiaries from Medicare prescription drug plans (i.e., MAPD and PDP) over 3 years.
Methods: Medicare Part D beneficiaries from the 2 drug plans were in 1
program regularly stimulating medication therapy management (MTM)
service in a 6-month period. Four such
periods occurring during 2010 to 2012
were identified as study periods. A cohort of Medicare Part D beneficiaries
aged ≥65 years from either plan and had
≥1 prescription in any study period was
included as study sample (n = 33,516).
Their prescription claims (n = 115,206)
generated throughout all study periods
were extracted for analysis. The percent
of beneficiaries using HRM was plotted
for the 2 plans across the 4 study periods.
Additionally, a generalized estimating
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APhA2014 ABSTRACTS
equation model was fitted to assess factors associated with likelihood of filling
HRM among Medicare Part D beneficiaries who were potential MTM users. All
statistical analyses were performed in
SAS (version 9.3) and R (version 2.15).
Results: The percent of beneficiaries
using HRM declined over 4 study periods across both plans. The likelihood of
filling HRM was significantly decreasing
over time, controlling for other factors
(P< 0.0001). Additionally, the association between likelihood of filling HRM
and number of non–high-risk prescriptions (non-HRM), age, or sex significantly depended on prescription drug
plan (P<0.0001). In either plan, female
patients and younger elderly patients
were found to have a higher likelihood of
filling HRM compared with their counterparts.
Conclusion: The use of HRM among
beneficiaries in 2 Medicare drug plans
decreased during 2010 to 2012. This
trend might be explained by strategies
implemented by the Centers for Medicare and Medicaid Services and the
MTM program. Such strategies include
having HRM use in drug plan quality
(Star) ratings, MTM intervention targeted at HRMs, and efforts to increase comprehensive medication reviews.
334—MANAGEMENT AND STANDARDIZATION OF PEDIATRIC PRIMARY CARE CLINIC MEDICATION
STOCK LISTS. Prusa C, Sebastian S,
Nationwide Children’s Hospital, E-mail:
sonya.sebastian@nationwidechildrens.
org
project is to evaluate and standardize
the medication stock lists for 9 pediatric
primary care clinics (PCC) within a pediatric hospital network. It is important to
stock medication in clinic to administer
necessary therapy. Multiple barriers to
safe medication use in PCCs exist, such
as rotating staff, inconsistent stock lists,
and unavailable technology. The current
stock lists contain medications that are
rarely used and have multiple strengths.
In addition, PCCs are currently not
equipped with barcode scanning or automated dispensing cabinets as a patient
safety measure. Regardless of location,
e198 JAPhA | 5 4:2 | M AR/AP R 2014
safety will be enhanced by revising the
stock lists and increasing the staff’s
knowledge of available medication.
Methods: A usage report of medication administered in clinics from December 2012 through September 2013 will
be obtained from the hospital electronic
medical records. Each medication on the
stock list will be evaluated for appropriateness. Medications will be removed
if usage does not warrant keeping the
medication on the lists. Multiple dosage
forms and strengths of medication will
be consolidated to cover patients’ needs
but minimize confusion. Revised lists
will be proposed to the department chair
and the head of nursing for approval. After approval, inventories will be updated
to reflect the revisions.
335—OREGON BOARD OF PHARMACY WORKPLACE SURVEY RESULTS. Zweber A, Oregon State University, E-mail: ann.zweber@oregonstate.
edu
Objective: The Oregon Board of
Pharmacy conducted a survey of licensees to: (1) identify the scope of pharmacists’ concerns about work environment;
(2) identify specific concerns about
workplace conditions; (3) identify and
quantify workplace setting and practices
that impact patient safety; and (4) inform
decisions and actions by the Oregon
Board of Pharmacy.
Methods: A 9-question electronic
survey was sent to all Oregon licensed
pharmacists with an e-mail address on
file. The survey, conducted in July 2011,
elicited perceptions of workplace factors affecting patient safety. Quantitative
data from demographic and Likert scale
questions, and qualitative responses
from comments were analyzed using
SPSS 19.0 and NVivo10.
Results: A 29% response rate yielded 1,401 completed surveys. Over 40% of
respondents disagreed or strongly disagreed with statements about adequate
time for breaks, and lunches, and satisfaction with time to do their job. Over
30% disagreed or strongly disagreed
with statements regarding adequate
pharmacist and technician staffing. Further breakdown indicated significant
ja p h a .org
differences in work setting and pharmacist role. Over 500 respondents provided written comments, with the most
frequent concerns being about staffing,
breaks, and productivity metrics.
Conclusion: The survey results highlighted workplace and patient safety issues for the Oregon Board of Pharmacy.
Subsequently, the Board adopted rules
to address work environment factors
that may negatively affect patient safety.
A follow-up survey was conducted 1
year after the rules went into effect.
336—PATIENT UNDERSTANDING
AND PREFERENCES FOR COMMUNITY PHARMACY QUALITY MEASURES INFORMATION. Shiyanbola
O, University of Wisconsin–Madison,
Mort J, Harris T, Christensen A, South
Dakota State University, E-mail: [email protected]
study are to: (1) describe patient understanding of community pharmacy quality measures; and (2) describe patient
preferences for community pharmacy
quality information.
Methods: Semi-structured focus
groups combined with survey methodology were conducted in urban and
rural areas of a Midwestern state. Patients who utilized community pharmacies and had a chronic illness discussed
their understanding of Pharmacy Quality Alliance–approved quality measures.
Questions examined preference of pharmacy quality information rating systems
(e.g., stars versus percentages) and desired data display and formats. During
the focus group discussions, participants
completed a survey examining their
understanding of each pharmacy quality measure. All discussions were audiorecorded and transcribed verbatim. Data
were analyzed using thematic analysis
and descriptive statistics.
Results: Thirty-four patients participated (mean age = 62.85 years; standard
deviation = 16.05). Patients were unfamiliar with quality measures information and their level of understanding differed for each quality measure. Survey
results indicated most patients understood “drug-drug interactions” (94.1%
of patients understood) and “helping pa-
APhA2014 ABSTRACTS
tients get needed medications” (94.1%)
better than other measures (76.5% to
79.4%). Qualitative analysis indicated
patients preferred an overall pharmacy
rating displayed for quick access and
use. However, patients wanted quality measures information displayed by
health conditions. Patients disliked the
“lower is better” format in comparing
pharmacies and favored a comparison
of their pharmacy to city data instead of
state data. Patients had mixed feelings
regarding the star rating system versus
other methods of displaying data. In
general, most patients liked star ratings
better than percentages, grade letters, or
numerical ratings. Patients understood
the Medicare star rating better than a bar
graph system, which they found confusing and difficult to comprehend.
Conclusion: Specific quality measures were not understood by up to a
quarter of patients. Patients had specific
preferences for the display of pharmacy
quality information, which will be helpful in the design of appropriate quality
report systems.
337—PERCEIVED VALUE OF PHARMACY
QUALITY
MEASURES
AMONG PATIENTS USING COMMUNITY PHARMACIES. Shiyanbola
O, University of Wisconsin–Madison,
Mort J, Harris T, Christensen A, South
Dakota State University, E-mail: [email protected]
Objective: This study examined patients’ use of quality measures in evaluating and choosing community pharmacies.
Methods: Patients with a chronic
illness, taking prescription medications
and filling prescriptions in pharmacies
participated in semi-structured focus
groups that assessed the value of Pharmacy Quality Alliance–approved community pharmacy quality measures in
evaluating and choosing a pharmacy.
During the focus groups, participants
completed questionnaires rating their
perceived value of quality measures
in evaluating a pharmacy (1 = low; 5 =
high) or choosing a pharmacy (yes/no).
Data were analyzed using thematic analysis and descriptive statistics.
Results: Thirty-four adults par-
ticipated. While comments indicated all
measures were important, some measures were valued more highly than others (e.g., “helping patients get needed
medication,” “use of high-risk medication in the elderly,” “drug-drug interactions”). The value of disease-specific
measures related to diabetes, asthma,
or hypertension treatment depended on
whether the patient had the condition.
Some patients questioned the pharmacist’s role in measures examining adherence. Rating of quality measure utility
in evaluating a pharmacy ranged from
4.88 (“drug-drug interactions”) to 4.0
(“suboptimal treatment of hypertension
in patients with diabetes” and “absence
of controller therapy for persons with
asthma”). Patients hesitated to use quality information to choose their pharmacy
(depending on participant’s location) but
may consider if moving to a new area.
Use of select quality measures to choose
a pharmacy ranged from 97.1% of participants using “drug-drug interactions”
to 55.9% using “absence of controller
therapy for persons with asthma.”
Conclusion: Patients valued pharmacy quality measures in evaluating a
community pharmacy with general safety measures valued highest. In addition,
safety measures were more likely to be
used to select pharmacies. Quality measures would not typically cause a switch
in pharmacy but may influence selection
on relocation. In addition, community
pharmacy access in rural areas may limit
the possibility of switching pharmacies.
338—PERCEPTIONS ON E-PRESCRIBING SAFETY AND QUALITY.
Siracuse M, Galt K, Abbott A, Fuji K,
Bramble J, Paschal K, Creighton University, E-mail: [email protected]
Objective: The goal of this study
was to determine differences between
health care professionals (e.g., pharmacists, physicians, advanced practice
registered nurses, physician assistants,
registered and licensed practical nurses,
medical assistants, therapists, technologists) and organizational personnel (e.g.,
receptionists, billing staff, medical records staff, schedulers, information technology support including management
and clinical informatics, chief executive
j apha.org
and chief financial officers, practice manager/administrator, business manager)
regarding safety and quality of e-prescribing in rural ambulatory care practices and pharmacies.
Methods: Health care professionals
and organizational personnel at 5 rural
ambulatory care practices in Nebraska
and Iowa were surveyed. Each practice
had an affiliation with the local critical access hospital. At each site, a clinic
manager was identified as a facilitator
for survey administration. After the total
number of required surveys at each site
was determined, paper copies of surveys
were either hand delivered to the clinic
or sent via overnight delivery. Clinic facilitators distributed a 90-item survey,
of which 36 items were related to e-prescribing, and collected them 1 week later.
All survey items had a binary response
option.
Results: Surveys were distributed
to 164 individuals at 5 locations. A total of 141 surveys were completed for a
response rate of 86.0%. Chi-square tests
were run to determine differences in
responses between health care professionals and organizational personnel.
Statistically significant differences were
shown in 12 of 36 survey items. Organizational personnel sometimes indicated
e-prescribing as being safer compared
with health care professionals. For example, 68% of health care professionals
believed that e-prescriptions have been
sent to the wrong pharmacy compared
with 33% of organizational personnel
(P< 0.001). Additionally, 64% of health
care professionals believed e-prescriptions have been transmitted with incorrect information, compared with 27% of
organizational personnel (P < 0.001).
Conclusion: Perceptions about the
safety of e-prescribing may differ between health care professionals providing direct patient care and others in the
organization who have administrative
oversight or provide other support.
339 —PHAR M ACIST-INIT IAT ED
PSYCHOTROPIC
MEDICATION
REVIEWS TO ASSURE OPTIMAL
SAFETY MONITORING IN PATIENTS RECEIVING BEHAVIORAL
HEALTH SERVICES IN A FEDERMA R /APR 2014 | 54:2 |
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ALLY QUALIFIED COMMUNITY
HEALTH CENTER. Sokhal D, Gallimore C, University of Wisconsin, Schreiter E, Access Community Health Center,
Objective: As a quality improvement (QI) project, pharmacists perform
electronic health record (EHR) reviews
of psychiatrically complex patients to
provide recommendations regarding
appropriate monitoring of psychotropic
medications to primary care providers
(PCP). The objectives of this project are
to: (1) increase the percentage of patients
up to date on recommended laboratory
monitoring and Abnormal Involuntary
Movement Scale (AIMS) assessment for
psychotropic medications; and (2) minimize the percentage of patients at risk of
clinically relevant drug interactions.
Methods: Pharmacists quarterly
receive a list of patients who had 1-time
consultations with the clinic psychiatrist
from the behavioral health team. Pharmacists review the EHR, and document
and route recommendations to the PCP.
Data for each patient will be recorded
in a de-identified database that specifies whether laboratory monitoring and
AIMS assessment were up to date and
whether drug interactions were present
at time of pharmacy review (pre-data
set). A second retrospective EHR review
will be performed 2 months following
the initial pharmacy review for the same
patients to evaluate the same parameters (post-data set). Data will be used
to evaluate impact of the QI project by
comparing percentage of patients up to
date on laboratory monitoring and AIMS
assessment, and at risk for drug interactions following pharmacists’ recommendations. McNemar test will be used to
evaluate for statistically significant differences. Feedback will be collected from
PCPs via survey to evaluate the utility of
the QI project.
Results: Research in progress. Reviews for 4 quarters are targeted for QI
project; currently pre-data for first quarter (50 patients) and second quarter (18
patients) have been collected. Post-data
collection for 3 quarters will be completed to report improvement in parameters
being evaluated and results from statistical analysis using McNemar test.
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340—SANITATION
AWARENESS
AMONG PHARMACY ASSOCIATES
SETTING. Nguyen A, Lee K, Shell M,
Chyan V, University of Arizona, E-mail:
[email protected]
Objective: This project aims to create awareness and increase frequency of
sanitary practices in a community pharmacy to possibly prevent cross-contamination that may affect patient outcomes.
Methods: Pharmacy technicians in
a community pharmacy were observed
by the authors. Each observer monitored
up to 2 technicians at a time. Associates
manually counted medications on a
counting tray with a spatula. Cleaning
by wiping the counting trays with paper
towels and alcohol solution after use was
observed. Pre-intervention data were
collected for 1.5 months by observing
how often trays were cleaned. Technicians were previously untrained in proper tray cleaning. Associates were given
handouts explaining the importance of
cleaning counting trays and verbally and
visually educated on targeted medications: nonsteroidal anti-inflammatory
drugs (NSAIDs), sulfa derivatives, warfarin, chemotherapy agents, antibiotics,
and antivirals. Post-intervention data
were collected for 1.5 months. The frequency of trays cleaned after use was
recorded and analyzed using chi-square
(alpha <0.05). This quality improvement
project does not meet the federal definition of research and institutional review
board approval was not required.
Results: Six pharmacy associates
were observed for 48 hours pre-intervention and 50 hours post-intervention.
In pre-intervention, counting trays were
cleaned 14% of the times they were used,
which increased to 54% post-intervention (P<0.001). Cleaning practices increased post-intervention for all targeted
medications: NSAIDs (75.9% cleaned),
sulfa derivatives (83.0% cleaned), warfarin (96.0% cleaned), chemotherapy
agents (58.3% cleaned), antibiotics
(81.1% cleaned), and antivirals (66.7%
cleaned), all showing P<0.001.
Conclusion: Through this intervention, an increase of 40% was observed
in tray cleaning from pre- to post-intervention. This may lead to a reduction
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in cross-contamination of medications.
Future research should focus on how
sanitation practices improve the prevention of cross-contamination adverse reactions.
341—TIME REQUIREMENTS FOR
CRITICAL-TO-QUALITY PHARMACIST INTERVENTIONS. Yee K, Bingaman M, Li P, Patel P, Yip S, University
of Arizona College of Pharmacy, E-mail:
[email protected]
Objective: The objective was to measure the actual time community pharmacists needed to complete specific criticalto-quality tasks that were directed to
patients and prescribers. The goal was
to examine if time allocated by the company to perform these critical-to-quality
functions was adequate.
Methods: For this observational
quality improvement (QI) project, student observers collected data at 3 different stores belonging to the same grocery store pharmacy chain in Tucson,
Arizona, every Friday from 10:00 to 14:00
for 5 weeks. Observers used electronic
timers to measure time spent completing critical-to-quality tasks by pharmacists as well as by student pharmacists.
Observed times for each task were normalized and compared with pharmacy
chain’s projected times using a 2-tailed
independent Student t test. An alpha
of 0.05 was selected a priori. This was a
QI project therefore it did not meet the
federal definition of research and institutional review board approval was not
required per university guidance.
Results: During the 5-week study,
60 hours of total data were collected. The
observed proportion of time required
for patient counseling was significantly
greater than projected (mean observed =
0.099, standard deviation [SD] observed
= 0.0187, mean projected = 0.066, SD
projected = 0.00072, P = 0.041). At specific locations, the significant differences
were identified between observed and
projected times for patient counseling
(P = 0.010) and customer phone calls (P
= 0.001). Observed times for non-patient
interaction tasks such as prescription
verification, prescriber phone calls, and
voicemail prescription retrieval were not
significant (P>0.05).
APhA2014 ABSTRACTS
Conclusion: Overall, observed time
for patient-interaction tasks such as
counseling and customer phone calls at
certain stores required more time than
the company allotted for these tasks.
This mismatch between allotted times
for job-related functions and the actual
time required to perform tasks may increase the risks for medication errors and
job-related stress.
342—TRANSITIONS OF CARE IN
HEART FAILURE PATIENTS: IDENTIFYING PATIENTS FOR INTERVENTION. Miles A, Gunning K, University of Utah Hospitals and Clinics,
Stevens V, University of Utah, Jennings
B, University of Utah Hospitals and Clinics, E-mail: [email protected]
Objective: Studies recognize transitions of care as a significant cause of confusion, errors, and miscommunication
with patients, families, and health care
providers. The objective of this study is
to define what drug-related problems occur during transitions of care at time of
discharge from the hospital and at time
of primary care physician follow-up. The
study will categorize baseline characteristics of each patient to assess which patients are at higher risk of experiencing a
drug-related problem. This process can
be utilized to adapt practice models for
pharmacists to identify patients for possible interventions.
Methods: This descriptive study will
identify patients with a heart failure admission to the hospital. A retrospective
chart review will be performed on 100
patients. The charts will be reviewed in
reverse chronological order based on
date of admission. This study will assess
each chart for drug-related problems at
time of hospital discharge and time of
primary care physician follow-up based
on current evidence-based guidelines.
The data collection process also will include collection of demographic data.
This study will identify patients who the
pharmacist should target for intervention.
Q 343—UTILIZATION OF A STANDARDIZED ASSESSMENT TOOL
TO PROPEL PHARMACY PRACTICE
IN A MILITARY TREATMENT FACILITY. Hellwig H, Gunter J, Fort Belvoir Community Hospital, E-mail: [email protected]
Objective: The American Society
of Health-System Pharmacists (ASHP)
published a Pharmacy Practice Model
Initiative (PPMI) to propel the practice
of pharmacy. The objective of this presentation is to describe the utilization of a
standardized assessment tool to measure
progress and determine future plans for
change to a pharmacy practice model.
Methods: A team of pharmacists
and pharmacy technicians representing all sections of the pharmacy was
assembled to complete ASHP’s PPMI
hospital assessment. Areas of weakness
in the assessment were categorized by
feasibility and importance to determine
goals for implementation. After 1 year,
the assessment was repeated to assess
progress and determine goals for implementation. After 1 year, the assessment
was repeated to assess progress and determine focus areas for the second year’s
implementation. Teams were formed
to address each focus area and develop
performance improvement projects that
targeted these areas.
Results: The utilization of the hospital assessment tool identified baseline
compliance with PPMI recommendations of 40% in Optimal Pharmacy Practice Model Characteristics Part I, 28% in
Advancing the Use of Pharmacy Technicians, and 57% in Successful Implementation of New Pharmacy Practice Models. After 1 year, improvements of 33%,
14%, and 20%, respectively, were noted,
demonstrating significant improvement
in compliance with PPMI recommendations. These improvements were due
to efforts to increase clinical responsibilities of inpatient staff pharmacists and
increase responsibilities of pharmacy
technicians. The repeat assessment was
utilized to identify 5 areas for improvement that have been targeted for current
performance improvement initiatives.
Conclusion: The utilization of a standardized assessment tool at baseline and
at set intervals assists in the documentation of progress resulting from change
initiatives and is used to determine next
steps for practice enhancements. This
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method of identifying weaknesses and
making systemic improvements could
be utilized throughout every area of
pharmacy practice.
Original Citation: Gunter A, Hellwig H, Maroyka E. Utilization of a standardized assessment tool to propel pharmacy practice in a military treatment
facility. JAPhA. 2013; 53:e151-e170.
Respiratory Care
344—ANALYSIS OF ASTHMA ACTION PLANS DEVELOPED AND
MONITORED BY PHARMACISTS
SETTING. Aguilar E, Pope N, Lawson
K, Wilson J, The University of Texas at
Austin, Bierle H, H-E-B Pharmacy, Montemayor D, H-E-B, E-mail: s0915a@heb.
com
study is to evaluate the effectiveness of
asthma action plans that are developed
and monitored by community pharmacists in collaboration with health care
providers.
Methods: Participants will be selected using profiles from community
pharmacy locations within the Austin,
Texas, region. Ideal candidates will be individuals with asthma treated with multiple medications. Participants with no
existing action plan will be provided an
action plan along with a brief overview
of the action plan and review of medications. The participant’s primary health
care provider will be contacted and informed of the patient’s desire to create
an asthma action plan. With collaborative efforts between the pharmacist and
health care provider, a personalized action plan will be created. The medication
history will be reviewed for 3 months
prior to commencement of the action
plan to establish the baseline frequency
of medication fills. The participants will
be monitored for 3 months following
initial review of the asthma action plan.
Effectiveness of the asthma action plan
will be measured by completion of surveys at the beginning and conclusion of
the study. Questions on the surveys will
be designed to determine understanding
and ease of use of the action plan in addition to disease state management related
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APhA2014 ABSTRACTS
items such as number of exacerbations
per month. Self-reported medication
adherence forms completed by the candidates will measure medication adherence.
assess group differences in demographic
variables (IM versus FM patients). Chisquare tests will be used to evaluate differences in guideline implementation
rates for IM versus FM patients.
345—EVALUATION OF EVIDENCEBASED MANAGEMENT OF ADULT
ASTHMA PATIENTS IN A PRIMARY CARE CLINIC. Wiechman B, University of Wisconsin–Madison, Schutten
K, Statz-Paynter J, Dean Clinic, Zorek J,
University of Wisconsin–Madison, Email: [email protected]
Objective: The primary aim of this
study is to determine the percentage of
patients with asthma receiving evidencebased pharmaceutical care according to
National Asthma Education and Prevention Program (NAEPP) guidelines in a
primary care clinic consisting of internal
medicine (IM) and family medicine (FM)
departments. A secondary aim is to compare NAEPP guideline implementation
rates for IM versus FM patients.
Methods: In this retrospective cohort study, patient records from the IM,
FM, and pharmacy departments of this
primary care clinic will be reviewed and
analyzed. At least 1 asthma-specific International Classification of Diseases–9th
revision (ICD-9) diagnosis code will be
required for inclusion. Exclusion criteria
include ICD-9 codes specific to chronic
obstructive pulmonary disease, cystic
fibrosis, and emphysema or evidence of
other lung-related comorbidities such as
prescribed medications for these conditions. Demographic data and asthmarelated symptomatology (e.g., asthma
exacerbations, frequency of nighttime
symptoms, urgent care visits/hospitalizations) will be collected from medical records. Pharmacy records will be
reviewed to document asthma-specific
medication regimens and related information (e.g., dispensing data to evaluate
adherence, use of oral steroids). Medication regimens will be compared with
NAEPP guidelines to determine guideline implementation rates. Descriptive
statistics will be used to characterize
patients and calculate guideline implementation rates. Independent sample t
tests and chi-square tests will be used to
346—KNOWLEDGE AND ATTITUDES ON LUNG HEALTH AMONG
COLLEGE STUDENTS. Salgia A, Viscosi C, Janansky J, Lin Y, Mansukhani
R, Rutgers, The State University of New
Jersey, E-mail: [email protected]
is to evaluate the knowledge and attitudes of college students before and after
attending a 1-hour educational program
about lung health and how it impacts social behaviors.
Methods: A 20-question pre- and
post-survey will be provided to both
pharmacy and nonpharmacy college students to assess baseline knowledge and
attitudes about lung health. Two 1-hour
educational sessions will be developed
and implemented by student pharmacists. At the end of the session, a postsurvey will assess the knowledge gained
from the program and how it affects
future choices compared with current
behaviors. The aim is to seek the differences initially within each group and to
prove an education program will lead to
similar behaviors.
hypothesis is that the pharmacy students
will have a higher overall point total for
baseline knowledge compared with the
nonpharmacy students. However, both
groups are anticipated to have improvement in knowledge after the 1-hour session. It is expected that a higher education level on lung health will allow college students to make healthier choices.
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Substance Abuse and Addictions
347—A CONSENSUS-BASED CLINICAL TOOL FOR EVALUATING CONTROLLED SUBSTANCE USE PRIOR
TO DISPENSING AT COMMUNITY
PHARMACIES WITHIN A HEALTH
SYSTEM. Carbo A, Gehrke S, University of Wisconsin Hospital and Clinics,
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is to: (1) create and pilot a consensusbased clinical tool that standardizes the
data-gathering and decision-making
process for evaluating controlled substance use prior to dispensing at community pharmacies within a health system;
(2) evaluate pharmacy staff competency
and confidence with this clinical tool; (3)
improve documentation of evaluations
and subsequent pharmacist interventions.
Methods: A modified Delphi consensus exercise will be used to create a
clinical tool for pharmacy-initiated evaluations of controlled substance use. An
initial list of draft statements, decision
points, and recommended actions will
be generated from a literature review
of relevant strategies, including pharmacy utilization of state prescription
drug monitoring programs. Following
review by an advisory group composed
of clinical pharmacists and pharmacy
managers, items will be presented to an
expert panel via a web-based questionnaire to approve and discuss inclusion
in the clinical tool. The expert panel will
include physicians, nurse practitioners,
pharmacists, and other stakeholders.
Recommendations receiving a high level
of agreement from the workgroup will
be incorporated into the final draft of the
clinical tool to be endorsed by the advisory group. Educational programming
will be developed to train pharmacy staff
on the clinical tool, with corresponding
pre- and post-training competency and
confidence assessments. Subsequently, a
3-month pilot will be conducted at multiple community pharmacy sites within
the health system. All controlled substance prescriptions and fills presenting
at the pilot pharmacies will be eligible for
evaluation via the clinical tool. Continuous feedback will be obtained from pilot
participants via web-based questionnaires, with potential revisions reviewed
by the advisory group. Evaluations and
subsequent pharmacist interventions
will be documented in the pharmacy
dispensing software via a standardized
process. Documentation rates and pharmacist interventions will be reported
monthly during the pilot.
APhA2014 ABSTRACTS
348—DOCUMENTATION
OF
SMOKING
STATUS:
RESULTS
FROM A RANDOMIZED TRIAL
TO PROMOTE BRIEF SMOKING
CESSATION
INTERVENTIONS
IN COMMUNITY PHARMACIES.
Corelli R, Kroon L, University of California, San Francisco, Vatanka P, Safeway
Incorporated, Rodondi K, University of
California, San Francisco, Hille B, Safeway Incorporated, Hudmon K, Purdue
University, E-mail: corellir@pharmacy.
ucsf.edu
study are to compare the effects of 2
training approaches on the extent to
which pharmacy personnel (pharmacists and technicians) ask patients about
tobacco use and document smoking status in community pharmacy dispensing
systems.
Methods: In a randomized trial to
promote brief pharmacy-based smoking cessation interventions and referrals
to a tobacco quitline, pharmacy personnel in 20 chain grocery store pharmacies received either (1) a written training
program [W] or (2) a written + 4-hour
live training program + active monitoring and coaching by pharmacy management [W+L]. Self-reported cessation
interventions were assessed through
surveys completed by pharmacy personnel (baseline, post-training, and 6- and
12-weeks post-training). The proportion
of active patient profiles with documented smoking status was monitored prospectively through weekly store metrics
reports, characterizing only profiles with
dispensing activity during the study
period. The study was approved by the
Human Research Committee.
Results: At baseline, most pharmacists (37 of 44; 84%) and technicians (53
of 55; 96%) indicated that they had asked
zero patients about their smoking status
in the past week. At the 12-week followup survey, the percentage of pharmacists
asking zero patients had decreased to
14% and 15% in the W and W+L group,
respectively, and among technicians to
25% and 9% in the W and W+L group,
respectively. Similarly, documentation
of smoking status in the pharmacy patient profiles at 6 and 12 weeks was 26%
and 27% for the W group, respectively,
and 35% and 45% for the W+L groups,
respectively. A significant betweengroup difference was observed for the
overall proportion of active profiles with
documented smoking status at week 12
(P<0.05). Overall, pharmacy personnel
reported high levels of perceived success
in implementing brief smoking cessation
interventions.
Conclusion: Community pharmacy
personnel are able to effectively and consistently integrate the identification and
documentation of smoking status as a
routine component of practice.
349—NALOXONE-BASED
HARM
REDUCTION: IMPLEMENTATION
IN THE STATE OF KENTUCKY. Riner
E, Wermeling D, University of Kentucky
College of Pharmacy, E-mail: dwermel@
uky.edu
Objective: This document provides
a how-to guide for implementing programs in Kentucky that prescribe naloxone for third-party administration with
the goal of preventing opioid overdose
deaths.
Methods: Per Kentucky Revised
Statute 217.186, effective June 24, 2013,
health care providers acting in good faith
can prescribe and dispense naloxone for
administration by a third-party during
an opioid overdose. Additionally, the
third-party administering naloxone to
whom it was prescribed shall not be subject to civil liability as long as he or she
were acting in good faith and immediately called 911. These amendments to
the Kentucky Food, Drug, and Cosmetic
Act present a unique opportunity for
pharmacists to create programs involving prescribing and dispensing naloxone
to prevent opioid overdoses. Kentucky
not only has the second-highest rate of
accidental prescription painkiller overdose, but is also facing a growing heroin
problem resulting from the 2012 House
Bill 1, which limited access to prescription opioids. Kentucky has a need for
harm reduction via naloxone to improve
its citizens’ health and safety. Completing this project required research of existing naloxone programs’ practices and
integrating information and guidelines
from the Centers for Disease Control and
Prevention, the Substance Abuse and
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Mental Health Services Administration,
and the Office of National Drug Control.
protocol contains guidance for pharmacists wishing to incorporate naloxone into their practices, including legal considerations, prescription templates, specific
setting applications, billing, and working with prescribers to identify high-risk
individuals and implement prescribing.
An important aspect of this protocol is
educating patients and their family and/
or friends about overdose prevention,
recognition, and response. Implementing this protocol will include distribution
via state pharmacy organizations, notifying practitioners through newsletters,
and contacting pharmacists directly. By
putting the information outlined by this
protocol into practice, pharmacists will
improve opioid-related patient safety
and prevent opioid overdose deaths.
Specialty Pharmacy
350—DEVELOPMENT AND ASSESSMENT OF A NEW PHARMACY
SERVICE FOR PATIENTS WITH
MULTIPLE SCLEROSIS. Luli A, Schiavo K, Zook T, NorthShore University
HealthSystem, E-mail: aluli@northshore.
org
to develop and assess a new pharmacy
service for the procurement, dispensing,
processing, and monitoring of specialty
medications for patients with multiple
sclerosis (MS) in an outpatient pharmacy.
Methods: A need for a focused pharmacy service has been identified in MS
patients within a health system in the
northern Chicago suburbs. A voluntary
survey of clinicians in the neurology
department will be conducted to define
the specific need that this service should
fulfill. The survey will ask whether clinicians think pharmacy involvement will
be beneficial for their practice, whether
patients are currently being educated on
medication-specific issues, and whether
current practices for procuring, monitoring, and assessing adherence to specialty
medications could be improved with
pharmacist involvement. The survey
will be distributed via e-mail to clinicians
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APhA2014 ABSTRACTS
including physicians, nurses, physician
assistants, and medical assistants who
care for patients with MS. The survey
also will ask for an explanation of the
responses provided. The service will
then be implemented and tailored based
on the survey responses. Following a
2-month implementation period, a postsurvey will be sent via e-mail to the same
clinicians. This survey will ask whether
the service was beneficial and whether
obtaining, monitoring, and assessing
adherence was improved with pharmacist involvement. Responses will be
compared with the pre-implementation
survey and will serve to identify weaknesses of the service and areas for improvement. Additionally, the results can
help pharmacists in similar practice settings anticipate issues when developing
a comparable service for any specialty
medication. Ideal characteristics of the
service will include: procurement; insurance adjudication; obtaining access and
dispensing products in compliance with
any and all regulatory mandates; and
providing clinical services that will include patient counseling and therapeutic
monitoring.
351—IDENTIFYING
FACTORS
THAT INFLUENCE SELECTION OF
PHARMACIES FOR SPECIALTY
MEDICATIONS. Dyson A, Blom J,
Walgreens Health-System Pharmacy,
Kuehl P, University of Missouri–Kansas
City, E-mail: [email protected]
Objective: Individual patients cared
for in this health system are being referred to multiple pharmacies. While this
pharmacy fills prescriptions for these
patients’ more traditional medications,
prescriptions for their specialty medications are not received here. This research
group believes it is best practice for patients to receive all of their medications
from one pharmacy. Thus, the objective
of this study is to identify factors affecting how ambulatory care providers in
this health-system determine to which
pharmacies they refer their patients for
specialty and limited-distribution medications.
Methods: Providers and staff from
ambulatory care clinics located on the
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premises of this health system will be
surveyed using online survey software
(Survey Monkey). The survey will be
developed and piloted to ascertain,
from the perspective of clinic personnel, those characteristics of a pharmacy
they believe best meets the needs of their
patients. Attributes regarding provider
preferences and patient factors/barriers to obtaining medications will be collected, with emphasis on those services
a pharmacy could provide to assist the
clinic and patients with obtainment and
adherence to specialty medications.
For this study a specialty medication is
a high-cost (e.g., >$500/month), selfadministered medication that may be
limited to certain pharmacies that meet
qualifications set by the manufacturer.
Nominal data will be analyzed using
descriptive statistics. Study participation
will be voluntary and confidential. No
financial incentives will be offered. This
study will be submitted for approval by
the Social and Behavioral Sciences institutional review board of this institution
before initiation.
Results: Research in progress. Based
on the findings, educational and other
promotional materials will be developed
and presented to clinic personnel to address the concerns and barriers identified. Following this marketing intervention, we hope that patients will be able
to fill all of their medications at a single
pharmacy, allowing for a complete assessment of medication safety and adherence.
352—UTILIZATION OF AN ORAL
CHEMOTHERAPY PRESCRIPTION
QUEUE TO INCREASE ERROR RECOGNITION AND IMPROVE PHARMACEUTICAL CARE PROVIDED
TO ONCOLOGY PATIENTS IN A
HEALTH SYSTEM. Bhargava E, Nanavati P, Northshore University Health
System, E-mail: pnanavati@northshore.
org
Objective: The purpose of this project is to validate the importance of an
oral chemotherapy order verification
system in the electronic medical record
(EMR) for pharmacists.
Methods: This project will be implemented in an outpatient oncology
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specialty pharmacy. It will entail assessing the functionality of the current oral
chemotherapy prescription queue and
identifying oncology patients receiving
oral chemotherapy medications from
oncologists within the health system. To
validate the need for an order verification system, pharmacists will screen for
dosing errors and inconsistencies while
documenting interventions. An oral
chemotherapy order verification checklist will be developed to assist pharmacists in identifying these errors. Using
this checklist, pharmacists will review
all oral chemotherapy orders placed by
oncologists within the health system. A
documentation tool will be created to
help quantify and categorize errors to
determine the impact pharmacists had
on patient outcomes. The data collected
by the utilization of the oral chemotherapy prescription queue in combination
with the documentation tool will help
justify the need for an oral chemotherapy
order verification system in the EMR.
Technology
353—APPLICATION OF THE SEIPS
WORK SYSTEM MODEL TO EXPLORE BARRIERS AND FACILITATORS TO ADDRESSING PROBLEMATIC E-PRESCRIPTIONS IN COMMUNITY PHARMACIES. Odukoya
O, University of Pittsburgh, Chui M,
Stone J, University of Wisconsin–Madison, E-mail: [email protected]
Objective: This study aims to explore barriers and facilitators to addressing problematic e-prescription errors in
community pharmacies using the Systems Engineering Initiative for Patient
Safety (SEIPS) work system and patient
safety model.
Methods: The study employed a
cross-sectional qualitative design and
was conducted at 5 community pharmacies in Wisconsin. Direct observations, interviews, and focus groups were
conducted with 13 pharmacists and 14
technicians. Interviews and focus groups
were audio-recorded. Recordings were
transcribed and subjected to thematic
analysis guided by the SEIPS model.
Results: The SEIPS model was use-
APhA2014 ABSTRACTS
ful in capturing work system constraints
related to people, use of e-prescribing
technology, organizational policies, and
the physical and external environments
that affect resolution of e-prescription
problems in community pharmacies.
This study found that organizational
factors such as communication, training,
teamwork, and staffing levels play a significant role in addressing e-prescription
problems. Other factors include: level of
experience; knowledge of the pharmacy
personnel; availability or usability of
tools and technology; interruptions and
time pressure when performing tasks;
and noise in the pharmacy environment.
Conclusion: Health care settings are
complex, time-pressed environments
where health care professionals interact with many patients taking multiple
medications. Electronic prescribing is
a health information technology that is
being used in health care settings nationwide to ensure safe prescribing of medications to patients; however problematic
e-prescriptions are encountered daily in
community pharmacy settings. Numerous work system factors appear to be important in addressing problematic e-prescription in community pharmacies. For
pharmacists to resolve e-prescriptions
efficiently, pharmacies must provide
the appropriate working conditions that
support use of e-prescribing systems.
Characteristics of the pharmacy organization such as staffing and training
on skills related to communication and
detecting e-prescription problems appear to be important. Further research is
needed to quantify work system factors
that may strengthen or weaken timely
resolution of e-prescription problems to
establish appropriate best practice safety
guidelines.
study are to: (1) assess patient satisfaction of a pharmacy counseling session
on inhaler use with video augmentation;
(2) determine the impact of these patient
counseling sessions on patient confidence of inhaler use; and (3) determine
utilization patterns of e-mailed counseling videos.
Methods: This is a prospective,
open-enrollment study that will be conducted in an independent community
pharmacy setting over a 3-month period.
For 3 months, participants who present
to the pharmacy with a new prescription for an inhaler medication will be
recruited for standard pharmacist-provided patient counseling with or without
augmentation of video technology on a
tablet computer (iPad). Patients will be
asked to complete an anonymous, selfadministered questionnaire about their
satisfaction and confidence of inhaler
use following the counseling session.
Results from patients whose counseling
session was not augmented with video
counseling will be compared with questionnaires from patients who were counseled with the use of video technology.
Patients will have the option of receiving
counseling videos through e-mail in addition to viewing them in the pharmacy.
Questionnaires will be analyzed to determine utilization patterns of the e-mailed
counseling videos. Patients <18 years
of age will be excluded from the study.
Data will be reported using descriptive
statistics in aggregate fashion. Results
will help to determine the impact of
video technology on augmenting pharmacist-provided counseling on new prescriptions for inhalers in a community
pharmacy setting and help to determine
which patient populations are more likely to utilize counseling videos.
354—WITHDRAWN.
355—EVALUATING THE USE OF
VIDEO TECHNOLOGY TO AUGMENT INHALER COUNSELING
STRATEGIES IN THE COMMUNITY
PHARMACY SETTING. Barrickman
A, Garofoli G, Elswick B, West Virginia
University, E-mail: [email protected].
edu
356—IMPLEMENTING A TELEPHARMACIST SERVICE FOR BEHAVIORAL HEALTH PATIENTS WITHIN AN INTEGRATED CARE SYSTEM. Rinkus M, Gonyeau A, University of Pittsburgh School of Pharmacy,
study are to: (1) evaluate how to best implement a pharmacist-provided patient
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care service remotely using interactive
audio-video technology for behavioral
health patients; and (2) subsequently determine the impact of the program on patient drug therapy problems and health
care costs.
Methods: This observational, prospective study is being conducted with
a partnership between the school of
pharmacy and Family Services of Western Pennsylvania. Case managers who
routinely evaluate behavioral health patients in their homes will serve as the liaisons to connect these patients to a pharmacist via interactive audio-visual technology deployed using tablet computers.
The pharmacist will conduct a comprehensive medication therapy review and
electronically document the patient’s demographics, history, drug therapy problem assessment, and care plan. Student
pharmacists will observe and document
the interactions. Observational data will
be collected using a structured tool and
analyzed for consistent themes. Data on
resolved therapy problems and potential
cost-saving opportunities will be collected and reported using descriptive statistics. The study will be evaluated by the
university’s institutional review board.
357—MOBILE APPLICATION FEATURES DESIRED BY PATIENTS OF
A GROCERY STORE CHAIN PHARMACY. McCartney E, Bacci J, University
of Pittsburgh School of Pharmacy, DelPizzo D, DeJames J, Richardson R, Giant
Eagle Pharmacy, McGivney M, University of Pittsburgh School of Pharmacy,
Objective: This study aims to determine the features of a pharmacy mobile
application that would be most valuable
to patients of a regional grocery store
chain pharmacy.
Methods: With the expansion of
both health care needs and technology services, electronic health (e-health)
services have allowed patients to better
connect and engage in their own health
care needs. It has been shown that those
patients who use pharmacy mobile applications spend more time at the pharmacy than those who do not use pharmacy mobile applications. This mixedMA R /APR 2014 | 54:2 |
JAPhA e205
APhA2014 ABSTRACTS
methods study will use focus groups
to determine how patients already use
mobile health-related applications, and
what features they would like to see in a
mobile application for the grocery store
chain. Focus group audio recordings
will be transcribed by a third party and
analyzed using grounded theory to elicit
themes. A survey will then be created
based on the major themes from the focus groups. The survey will be administered by student pharmacists in multiple
grocery store locations in the surrounding Pittsburgh area. Survey results will
be analyzed with descriptive statistics
to better describe patient interests. The
study will be evaluated by the university’s institutional review board.
Results: Research in progress. Focus
group and subsequent survey results
will provide guidance on the features to
design and include in a pharmacy mobile application and which features to
emphasize in the marketing of the application to patients.
358—NOVEL STRATEGY FOR BIOAVAILABILITY
ENHANCEMENT
OF POORLY SOLUBLE DRUGS EMBEDDED INTO ORAL POLYMER
FILMS. Kalaria S, Ernest Mario School
of Pharmacy, Rutgers University, Karry
K, Rutgers University, Michniak-Kohn
B, Ernest Mario School of Pharmacy,
Rutgers University, E-mail: michniak@
biology.rutgers.edu
is to optimize the formulation of naproxen polymer films and characterize the
final dosage form via nondestructive
spectroscopic techniques with the aim of
inhibiting drug recrystallization to improve its long-term stability. Polymeric
film dosage forms offer advantages such
as avoiding first-pass metabolism and
enzymatic degradation by allowing the
active pharmaceutical ingredient (API)
to be dissolved and absorbed in the oral
cavity. It is of importance to assure the
long-term stability of these polymer
films before delivering the medication
to patients. Crystallinity variations in an
API can affect its long-term stability, dissolution profile, and the expected therapeutic effects.
Methods: Naproxen, a poorly solu-
e206 JAPhA | 5 4:2 | M AR/AP R 2014
ble compound, was embedded into the
polymer films after solubilization with
novel graft copolymers. Excipients were
evaluated to optimize a formulation
with limited recrystallization. Different
grades and concentrations of polyvinyl
caprolactam graft copolymers (solubilizer/recrystallization inhibitor), water-soluble plasticizers, surfactants, bioadhesives, and additives were assessed. Each
polymer film solution was thoroughly
mixed for ≥8 hours before being casted
on a Teflon membrane and dried overnight in an oven at 40°C to 45°C. Post
drying, the films were peeled off and
characterized in terms of tensile strength,
percent elongation, physicochemical
interactions between the API and excipients via attenuated total reflectance
Fourier transform–infrared (ATR FT-IR)
spectroscopy, drug recrystallization, and
dosage form stability. Drug recrystallization was evaluated using scanning electron microscopy and prediction of the final stability was performed with the aid
of FT–near infrared and/or Terahertz
spectroscopic techniques. Further testing was then completed after exposing
the films to different temperatures and
humidity levels in accelerated stability
tests. Finally, biorelevancy comparisons
were carried out by dissolution studies
evaluating drug released over time from
the films containing the solubilized API
versus films with nanosized drug.
Results: Data collection and analysis
currently in progress.
359—PREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATION ORDERING FOR DRUGS
WITH SEDATIVE EFFECTS IN
ACUTE GERIATRIC INPATIENT
CARE
USING
ELECTRONIC
HEALTH RECORDS. Yu C, University
of California at San Francisco, Newman
C, Brisbane L, Zak M, Saubermann L,
University of Rochester Medical Center,
is to determine the baseline prevalence
and variables influencing potentially
inappropriate medication (PIM) ordering by utilizing pharmacoinformatics for
data mining and implementation of subsequent clinical advisory interventions
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to improve patient outcome.
Methods: Preventable adverse drug
events (ADE) of bone fractures from
falls, delirium, and gastrointestinal
complications, caused by sedative PIMs
with anticholinergic properties or in the
benzodiazepine class, in elderly patients,
≥65 years of age, can be reduced through
adherence to the Beers criteria, which
specifies high-risk medications for seniors. System analytics and structured
queries of electronic medical records
(EMR), from January 1, 2013 to June 30,
2013 retrieved criteria PIMs information from the medical center formulary
and medication orders in acute inpatient
care. Frequency analysis assessed PIM
ordering rates. Further evaluations by
clinicians excluded PIMs that were therapeutic to specific indications, isolated
PIMs that were consistently ordered
over safer alternatives, and characterized
the major factors that contributed to ordering PIMs.
Results: Retrospective inspection of
EMRs found 7,237 sedative PIM orders
for the identified 9 high-risk anticholinergic or benzodiazepine PIMs. Diphenhydramine had 2,361 orders (32.6% of
PIM orders), of which 46.0% were administered. The mean age was 73.6 years.
The mean therapy duration was 3.5 days,
and the mean hospital stay was 17.2
days. Seventy-two percent of the orders
were entry orders, and 26.4% came from
order sets of which 14.6% were admission order sets. Some reasons that led
to PIM ordering are outdated practices
and lack of knowledge about the impact
of PIMs. Computerized clinical decision
support can ameliorate PIM prescribing
behavior.
Conclusion: PIMs increase ADE
risks and hospitalizations for elderly
patients. Using pharmacy informatics,
baseline PIM prevalence was reported.
Implications of these findings are the
development of evidence-based targeted alerts and meaningful restrictions of
medications to provide relevant clinical
guidance and education in changing prescriber behavior and improving patient
outcome.
360—QUANTITATIVE ANALYSIS
OF MEDICATION UTILIZATION
APhA2014 ABSTRACTS
RATES FOR IMPLEMENTATION OF
AN OUTPATIENT PHARMACY AUTOMATED MEDICATION STORAGE CAROUSEL. Walsh A, University
of Arizona, Edwards B, Leon S, Southern
Arizona Veteran’s Affairs Healthcare
System, E-mail: [email protected]
Objective: The primary goal was to
determine the top 100 medications with
highest turnover and assign them to
specific carousel locations; the secondary goal was to educate pharmacists of
the new technology. Because of space
constraints, there was a need to implement an automated medication storage/
shelving carousel system to increase efficiency and maximize available floor
plan. Medication carousels are commonly utilized in inpatient pharmacies,
therefore the installation of this automation in an outpatient pharmacy setting
was unique.
Methods: Medication reorder point
(par) levels and fill frequencies from 2012
determined highest and lowest turnover
medications using Microsoft Excel. Accuracy of par levels was assessed; when
dosage form, container type, and corresponding units of medication were inappropriate, par levels were recalculated
to reflect current procurement trends.
The top 100 medications with the highest
turnover (fast movers) were assigned to
bins based on medication container size,
par levels, and estimated physical space
requirements of maximum (max) levels.
Many medications were assigned fractions of bins. Fast movers were grouped
on lowest-numbered rows to reduce
carousel spin time. Heavy items were
split among rows to distribute weight
and reduce mechanical stress. Medical
supplies, refrigerated medications, controlled substances, and heavy/bulky
items were not assigned a bin, but were
assigned barcodes and inventoried.
Results: The top 100 fast movers
were determined and assigned locations
in the medication carousel, which filled
approximately the first 8 rows. A presentation was delivered to interested pharmacy staff, who verbally expressed increased confidence and familiarity with
the technology.
Conclusion: The primary goal was
met, which was successful assignment of
the top 100 fast movers to carousel locations. The secondary goal was met, indicating that a summary presentation increased familiarity and successfully educated pharmacists about the timeline,
specifications, and calculations involved
with setup of a medication carousel in an
innovative practice setting.
361—UNDERSTANDING THE USABILITY OF PHARMACY DISPENSING COMPUTER SYSTEMS TO PREPARE AND DOCUMENT COMPREHENSIVE MEDICATION REVIEWS.
Scarpace K, Chui M, Kieser M, University of Wisconsin–Madison School of
study are to: (1) identify the usability of
pharmacy dispensing computer systems
in the preparation and documentation of
comprehensive medication reviews; and
(2) describe how pharmacists overcome
the limitations of pharmacy dispensing computer systems in preparing and
documenting comprehensive medication reviews.
Methods: Pharmacists employed
at pharmacies that conduct ≥1 comprehensive medication reviews per month
will be recruited for this study through
e-mail. One pharmacist from each recruited pharmacy will complete a survey
and observation conducted by the principal investigator. The survey assesses
various components within the pharmacy dispensing computer system and
their usability. During the observation,
the pharmacist will use the think-aloud
technique to walk the observer through
the typical workflow of preparation and
documentation of comprehensive medication reviews.
Results: Research in progress. Results from 5 to 8 pharmacy sites will be
presented.
Workforce and Manpower
362—DIFFERENCES IN CAREER
PATHS AND ATTRIBUTES OF
PHARMACISTS COMPLETING A
COMMUNITY PHARMACY RESIDENCY PROGRAM. Ulbrich T, Northeast Ohio Medical University, Adams
j apha.org
A, National Association of Chain Drug
Stores, Bright D, Sullivan D, Ohio Northern University, Schnur E, Walmart Stores
Inc., Bess D, University of Tennessee College of Pharmacy, Owen J, American
Pharmacists Association, Bradley-Baker
L, American Association of Colleges of
Pharmacy, E-mail: tulbrich@neomed.
edu
Objective: The study objective was
to determine any differences in career
paths and career attributes of pharmacists who have completed a postgraduate year 1 (PGY1) community pharmacy
residency program (CPRP) compared
with those who have not completed a
PGY1 CPRP.
Methods: A web-based survey evaluating various aspects of community
pharmacists’ careers was distributed
to 274 CPRP graduates in addition to
a random sample of 7,376 community
pharmacists. The survey contained 31
questions evaluating various career attributes. Questions that assessed level of
agreement were on a 6-point Likert-type
scale (1 = strongly disagree; 6 = strongly
agree).
Results: A total of 353 participants
completed the survey, with 224 indicating that they had not completed a CPRP.
No significant differences were observed
between CPRP and non-CPRP graduates
as it relates to employment status (employed full time vs. part time or unemployed), length of employment with the
primary employer, perceived workload,
number of job offers received following graduation (from school or from a
CPRP), or age. Pharmacists who completed a CPRP are more likely to spend
significantly more time on patient care
services, teaching, and research, and
spend less time dispensing medications.
CPRP graduates were less likely to agree
that current level of workload negatively
impacts job performance, motivation to
work, job satisfaction, mental/emotional
health, and physical health.
Conclusion: Pharmacists completing a CPRP noted significant differences
in their current employment and job responsibilities. Additional expansion and
education regarding the importance of
CPRPs should be considered.
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APhA2014 ABSTRACTS
363—EVALUATING
CURRENT
COMMUNITY PHARMACY TECHNICIAN TRAINING PRACTICES
FOR NEW EMPLOYEES. Robertson
K, University of Kentucky College of
Pharmacy/Kroger Pharmacy, Roberts
P, Kroger Pharmacy, Divine H, University of Kentucky College of Pharmacy,
E-mail: [email protected].
com
Objective: Pharmacy technician
training for new employees in the community pharmacy varies greatly among
pharmacies in the United States. These
training procedures range from on-thejob training to structured orientation
programs, including preparatory courses for pharmacy technician certification. In 1 division of a chain community
pharmacy, a newly employed pharmacy
technician receives training that includes
a series of computer-based modules and
a defined number of hours of on-the-job
training in the pharmacy. An assessment of the training components has
not been performed to determine areas
for quality improvement. The objectives
of the study are to: (1) evaluate current
pharmacy technician training practices
offered in the chain pharmacy division;
and (2) identify the need for additional
technician training components to further assist pharmacists with professional
patient care responsibilities.
Methods: Approximately 139 pharmacists and 139 pharmacy technicians
in 1 division of a chain community pharmacy will be invited to participate in a
group-specific survey. The survey will
assess the group’s (i.e., pharmacist or
technician) perspective of the current
training. The survey will be distributed
by e-mail and fax with options to anonymously complete either a web-based or
paper copy. The survey will be designed
to collect basic demographic information, assess current training practices for
pharmacy technicians, and explore pharmacy technician training needs for expanded clinical roles. Survey reminders
will be e-mailed and faxed to the pharmacies at weeks 3, 5, and 6. The study
will conclude at 6 weeks. Results will be
analyzed using descriptive statistics.
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364—IMPACT OF A PHARMACY
TECHNICIAN ON COST OF PROVIDING IN-HOME MEDICATION
THERAPY MANAGEMENT SERVICES. O’Connor S, University of
Washington, Akers J, Kelley-Ross and
Associates, E-mail: soconnor21@yahoo.
com
study was to determine the financial impact of incorporating a pharmacy technician into an in-home medication therapy
management (MTM) service.
Methods: Kelley-Ross (KR) Pharmacies is an independent 4-store pharmacy
that is contracted with a state agency to
provide in-home MTM for patients with
complicated medication regimens. Approximately 20 hours per week of a pharmacy technician’s time is used to cover
administrative tasks related to the MTM
service, including scheduling, billing,
assimilating documents, and running
reports. The technician was included in
workflow to decrease pharmacist time
spent on non-clinical tasks. Both pharmacist and technician time are tracked
as part of the requirement for the MTM
service. This study retrospectively examined the time used for patient care from
August 1 to September 30, 2013 using a
pharmacist and technician. This time
was compared with the amount that
would have been needed to accomplish
the same tasks if completed solely by a
pharmacist, which excluded activities
that would not be done if a technician
were not involved. Time measurements
were converted to cost to the pharmacy
based on pharmacy’s approximated cost
(salary plus benefits) of a pharmacist
($90/hour) and technician ($40/hour).
Results: Time was reported for 21
patients during the 2-month review period: 1,111 minutes of pharmacy technician and 2,227 minutes of pharmacist time were used, which equates to
$4,081.17. In a pharmacist-only scenario,
the time used is estimated at 3,119.2,
which equates to $4,678.80. Use of a
pharmacy technician uses 218.8 more
minutes but costs $597.63 less to care for
the same patient load.
Conclusion: It is less expensive to
have a pharmacist technician involved
in an MTM service, even if more time
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overall is used. This information is relevant for negotiating contract rates, as an
increased margin can be achieved by utilizing a technician for appropriate tasks.
365—LEVEL OF DEMAND FOR
PHARMACISTS IN COMMUNITY
PHARMACIES IN WISCONSIN.
Arora P, Mott D, University of Wisconsin–Madison, E-mail: [email protected]
Objective: The goal of this study is to
obtain statewide estimates of the level of
demand for pharmacists and pharmacy
characteristics for community pharmacies in Wisconsin and make comparisons
by rurality.
Methods: A descriptive, cross-sectional survey design was used. Surveys
were mailed to key informants (i.e.,
pharmacy managers/owners) for community pharmacies (N = 1,064) located
in rural and urban areas of Wisconsin
in July–August 2011 and March–April
2012, respectively. A 1-page cover letter and 3-page survey instrument were
used. Responses to the survey form
were submitted via fax. Nonresponders
received a second mailing 3 weeks after
the first mailing. The survey instrument
contained questions about the pharmacy
setting, workload, staffing characteristics, total and vacant number of budgeted full-time equivalent (FTE) pharmacist positions, and additional number
of unbudgeted FTE pharmacist positions
needed to attain adequate staff size.
Results: A total of 522 pharmacies
responded for a response rate of 49.8%.
A weighted total of 25.65 vacant budgeted FTE positions (represented by 1%
of the respondent pharmacies) were reported. The proportion of community
pharmacies with a vacant position was
significantly higher in rural areas than
in urban areas. The prescription volume
per day in the community pharmacies
did not differ significantly by rurality. Twenty-seven percent of key informants reported the need for additional
number of unbudgeted FTE pharmacist
positions. A weighted total of 316.37 additional unbudgeted FTE pharmacist positions were reported as needed in community pharmacies in Wisconsin.
Conclusion: Results suggest that
the unmet demand for budgeted phar-
APhA2014 ABSTRACTS
macist positions is close to being met in
community pharmacies in Wisconsin.
It is important to systematically assess
the level of demand for pharmacists to
understand the impact of the growing
supply of pharmacists and the economy
on the level of pharmacist demand and
to help pharmacy schools determine the
need for pharmacists in their states and
the United States.
366—A PROFILE OF PHARMACISTS
OF RETIREMENT AGE IN ILLINOIS.
Brown A, Quinones-Boex A, Mata D,
Midwestern University, E-mail: aquino@
midwestern.edu
study was to identify the set of characteristics that best describe pharmacists of
retirement age (>65 years) in Illinois. The
2009 National Pharmacist Workforce
Survey reported an increased proportion of pharmacists actively practicing
during 2004 through 2009, especially for
pharmacists aged ≥60 years.
Methods: A 4-page questionnaire
was mailed in early January 2013 to 500
pharmacists licensed and residing in
Illinois, randomly selected from a list
purchased from the Illinois Department
of Financial and Professional Regulation. One follow-up postcard reminder
was sent to the whole sample 2 weeks
from the original mailing. Data collection ended 3 months after the original
mailing date. The data were analyzed
using IBM SPSS. An alpha level of 0.05
was employed to determine statistical
significance.
Results: The response rate was
44.4% (n = 222). Most respondents reported being retired but still working
part-time (41.8%) or being retired and
not practicing pharmacy (39.5%). Twelve
percent reported practicing full-time as
pharmacists. Pharmacists of retirement
age who reported practicing pharmacy (full-time or part-time) were white
(99.2%) and male (87.4%). Their average
age was 74.7 years old. Statistically significant results showed that these pharmacists wish to spend more time providing patient care and engaging in other
activities (e.g., teaching, precepting,
research) and less time dispensing. Pharmacists working full-time have worked
significantly longer with their current
employer and were more likely to hold
managerial-type of positions. They also
were younger than their part-time counterparts.
Conclusion: An understanding of
practicing pharmacists of retirement
age has implications for employers since
growing market saturation has been partially attributed to a reluctance of older
pharmacists to retire due to the recent
recession. Results of this study suggest
that pharmacists of retirement age practicing in Illinois transition from full-time
practice to part-time practice between
the ages of 75 and 80 years.
Emerging Topics
OF A PEDIATRIC WEIGHT-BASED
DOSING PROCEDURE IN OUTPATIENT PHARMACY. Grant J, Johns
Hopkins Home Care Group, E-mail:
[email protected]
of this project is to describe the percentages of outpatient pediatric prescriptions
with initial inappropriate prescribing
identified by a pharmacist that resulted
in a dosage change among both pediatric prescriptions that required prescriber
contact for prescription clarification and
total number of pediatric prescriptions
dispensed. Secondary objectives include
describing categories of initial inappropriate prescribing errors, Institute for
Safe Medication Practices (ISMP) highalert medications, patient demographics,
prescriber office location, and prescription origin.
Methods: This retrospective outpatient prescription record review will be
performed at an outpatient pharmacy
located in an academic teaching hospital. The study will review pediatric prescriptions from a 6-month time period.
Data will be collected through the use
of the outpatient pharmacy’s database.
Two reports will be generated; one will
quantify all pediatric prescriptions during the 6-month time period and another
will describe pediatric prescriptions that
required pharmacist intervention and
prescriber contact. The prescriptions that
required pharmacist intervention will be
j apha.org
further analyzed to address the secondary objectives. To determine percentages
for the primary objective, 2 calculations
will be performed. The first calculation
will include the total number of prescriptions that required intervention and resulted in a dosage change divided by the
total number of pediatric prescriptions
filled at the pharmacy. The second calculation will consist of the total number of
prescriptions that required intervention
and resulted in a change in dosage divided by the total number of prescriptions
that required pharmacist intervention.
A Kruskal-Wallis 1-way ANOVA will
be used to compare the intervention type
with the different age groups, weights,
and sex and to compare the intervention
type with the different ISMP high-alert
medication categories. A chi-square test
will be used in comparing the rates of
prescribing errors from house staff versus non–house staff and hand-written
versus computer-generated prescriptions.
Q 368—APIXABAN IS EFFICACIOUS AND SAFE IN PATIENTS
WITH ATRIAL FIBRILLATION USING CONCOMITANT AMIODARONE: AN ANALYSIS FROM THE
ARISTOTLE TRIAL. Flaker G, University of Missouri Health System, Wojdyla D, Duke Clinical Research Institute,
Hohnloser S, Johann Wolfgang Goethe
University, Sullivan R, University of
Missouri Health System, Hylek E, Boston University School of Medicine, Garcia D, University of Washington, Lopes
R, Granger C, Duke University Medical
Center, Al-Khatib S, [email protected].
edu, Medicine, Cardiology and Internal
Medicine , E-mail: [email protected]
is to evaluate interactions between apixaban and amiodarone on clinical outcomes in the ARISTOTLE (Apixaban for
Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation)
trial. Compared with warfarin, apixaban
has been shown to reduce stroke, systemic embolism, mortality, and major
bleeding. When used with warfarin,
amiodarone may lead to poor control of
MA R /APR 2014 | 54:2 |
JAPhA e209
APhA2014 ABSTRACTS
international normalized ratio (INR) and
excess embolic and bleeding events.
Methods: ARISTOTLE included
18,201 patients randomized to apixaban 5 mg twice daily or warfarin (target
INR, 2–3). Endpoints, including stroke/
systemic embolism (SSE), major bleeding, and intracranial hemorrhage (ICH),
were summarized using rates/100 patient-years of follow-up. The Cox regression model was used to derive hazard
ratios (HRs) comparing apixaban versus
warfarin and test the interaction between
randomized treatment and amiodarone.
Results: From the overall population, 2,051 patients (11%) received
amiodarone at randomization, including 1,009 patients assigned to apixaban
and 1,042 assigned to warfarin. Patients
on amiodarone were younger (median
68 years vs. 70 years) and had a lower
mean CHADS2 (congestive heart failure,
hypertension, age ≥75 years, diabetes
mellitus, prior stroke or transient ischemic attack) score (2.0 vs. 2.1). Patients
assigned to warfarin and receiving
amiodarone had a lower mean time in
therapeutic range (TTR) than those not
receiving amiodarone (56.5% vs. 63%,
P<0.0001). Among patients on amiodarone, the yearly rate of SSE was 1.24% for
apixaban-treated patients and 1.85% for
warfarin-treated patients (HR 0.68, 95%
confidence interval [CI] 0.40–1.15); respective HRs (95% CIs) for major bleeding and ICH were 0.61 (0.39–0.96) and
0.46 (0.28–0.66). The yearly rate of SSE
among patients not taking amiodarone
was 1.29% and 1.57% for apixaban- and
warfarin-treated patients, respectively
(HR 0.82, 95% CI 0.68–0.99); respective
HRs (95% CIs) for major bleeding and
ICH were 0.72 (0.62–0.78) and 0.25 (0.09–
0.67).
Conclusion: Despite a lower TTR
with warfarin and amiodarone, the efficacy and safety of apixaban versus
warfarin is consistent in patients with
or without concomitant amiodarone
therapy.
Original Citation: Flaker G, Wojdyla D, Hohnloser S, Sullivan R, Hylek E,
Garcia D, Lopes RD, Granger CB. Apixaban is efficacious and safe in patients
with atrial fibrillation using concomitant
amiodarone: an analysis from the AR-
e210 JAPhA | 5 4:2 | M AR/AP R 2014
ISTOTLE trial. Presented at: American
College of Cardiology ACC.13 and i2
Summit; March 9-11, 2013; San Francisco, CA.
369—ASSESSING
FIREFIGHTERS’ AND FIRST RESPONDERS’
KNOWLEDGE AND PERCEPTIONS
OF THE VIAL OF LIFE PROGRAM:
DO THEY THINK PHARMACISTS
CAN HELP THIS PROGRAM SUCCEED?. Passafiume S, Brody Jr. P, University at Buffalo, E-mail: pmbrody@
buffalo.edu
study are to: (1) reveal the knowledge
and perceptions of firefighters and first
responders of the Vial of LIFE program;
and (2) determine whether these primary users believe that pharmacists may
successfully promote the Vial of LIFE.
Methods: The Vial of LIFE is a medical information program in which LIFE
stands for “lifesaving information for
emergencies.” The intent is for patients
to have their medical information in 1
place if they suffer a medical emergency
in their home. Minimal data exist regarding utilization of the program. The
study cohort was drawn from local firefighters and first responders in western
New York. Participants were asked to
complete a non-validated 15-question
survey that included a combination of
yes/no, fill-in-the-blank, rank order, and
Likert scale questions. The purpose was
to uncover participants’ base knowledge
of the program, assess participants’ opinions of the program, and reveal perceptions regarding the potential for pharmacist involvement.
Results: Response rate was not recorded. Sixty-nine participants completed the survey. Five participants (7.2%)
correctly defined the acronym (LIFE)
and 25 participants (36%) had heard of
the Vial of LIFE program previously.
Fifty-two participants (75%) agreed that
the Vial of LIFE program could help firefighters and first responders save lives
during emergencies. Moreover, 58 participants (84%) indicated that pharmacists could successfully promote the Vial
of LIFE program, with 23 (33%) citing
that pharmacists are accessible health
care providers and 22 (32%) citing that
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pharmacists understand the importance
of having medical information in 1 place.
Conclusion: Firefighters and first responders have limited knowledge of the
Vial of LIFE program, but perceive the
program as valuable. These primary users identify a potential role for the pharmacist in promoting the Vial of LIFE.
370—CHARACTERISTICS AND DETERMINANTS OF BUYING MEDICINES AND VITAMINS ONLINE.
Desai K, Chewning B, Mott D, University
of Wisconsin–Madison, E-mail: [email protected]
Objective: With increased use of the
Internet, more people buy medications
and health supplements online. A key
question is what opportunities providers get and their impact. This study aims
to test the following: (1) the association
between online buying and use of health
services; (2) the association between buying online and discussion of Internet
information with providers; (3) the association of discussion of Internet information with providers and perceived quality of communication with provider.
Methods: The National Cancer Institute’s 2007 Health Information National
Trends Survey was analyzed to study
online medication buying among Internet users (n = 5,074). Multivariate logistic
regression analysis identified factors associated with online buying.
Results: In 2007, 17% (n = 872) of Internet users bought a medication or vitamin online. Approximately 77% of online
buyers had a regular provider, but only
37.1% talked to the provider about online
information even though most visited
the provider ≥1 times per year (93.7%).
Multivariate analyses found Internet
health product consumers were more
likely to: (1) have insurance; (2) be aged
>50 years; (3) have an income >$50,000;
(4) visit providers ≥1 times during the
last year; (5) use complementary medicines; and (6) talk to their doctors about
Internet information. Additionally, individuals reporting being in poor health,
who were college graduates, with a regular provider and perceived the quality of
communication with provider to be fair
or good, were more likely to talk about
online information.
APhA2014 ABSTRACTS
Conclusion: The association of online buying with frequency of visits and
discussing online information, which
in turn was associated with perceived
quality of communication, reinforces
the importance of patient-provider relationships. This also suggests that health
care providers (e.g., physicians, pharmacists) have a potential role in educating consumers about evaluating online
pharmacies, products, and information.
However, both groups would need to
be prepared to fulfill this role well and
have strong communication skills as perceived by patients.
Q 371—THE COMMUNITY PHARMACIST’S ROLE IN TRANSITIONS
OF CARE: A QUALITATIVE THEMATIC ANALYSIS. Long B, The Ohio
State University, Kuhn C, The Kroger
Co., Hilligoss B, The Ohio State University, Broedel-Zaugg K, Marshall University, Bennett M, The Ohio State University,
is to identify the perceptions of the community pharmacist’s role in a patient’s
transition of care (TOC) as perceived by
health-system and community pharmacists.
Methods: This qualitative study
was done with 25 community and
health-system pharmacist participants
from the greater Columbus, Ohio, area.
Three separate focus groups consisting
of exclusively community pharmacists,
exclusively health-system pharmacists,
and a combined group were conducted.
Focus groups were audio-recorded and
transcribed, and then participant statements were thematically analyzed.
Results: Community and healthsystem pharmacists perceived that the
community pharmacist’s primary role in
a patient’s TOC is to provide patient education, which includes resolution and
explanation of drug-related problems
(DRPs). An identified opportunity for
collaboration between community and
health-system pharmacists was medication reconciliation. However, an identified barrier to this collaboration is lack of
a well-established hand-off mechanism
between settings. Both health-system
and community pharmacists also re-
ported that community pharmacists are
easily accessible and community pharmacists stated the desire to participate in
these services. Time and workload were
identified as the most common barrier
for community pharmacist inclusion in
TOC services.
Conclusion:
Community
and
health-system pharmacists perceive that
community pharmacists do have a role
with patient education and DRP resolution, specifically in regard to a patient’s
TOC. Pharmacists describe that community pharmacists are accessible and truly
desire to participate in TOC services to
ensure seamless patient care. Community pharmacists can assist in a patient’s
TOC by collaborating with health-system pharmacists through medication
reconciliation and establishing hand-off
mechanisms through discharge instruction receipt. As time and workload are
barriers, community pharmacy practice
models should evolve to allow and encourage participation in TOC services.
Original Citation: Long B, Kuhn
C, Hilligoss B, Broedel-Zaugg K, Bennett M. The community pharmacist’s
role in transitions of care: a qualitative
thematic analysis. J Am Pharm Assoc.
2013;53(2):e8-e117.
372—A COMPARISON OF THE EFFECT OF SHORT INTERMITTENT
AND PROLONGED INTERMITTENT INFUSION OF MEROPENEM
ON THE PREVALENCE OF NAUSEA
IN PEDIATRIC PATIENTS WITH
CYSTIC FIBROSIS. Draime J, Nicholls
J, Sibbitt B, Gryka R, Simpson D, Cedarville University, E-mail: [email protected]
study are to: (1) assess nausea of pediatric patients with cystic fibrosis (CF)
following prolonged and short intermittent administration of meropenem
by comparing episodes of emesis, doses
of anti-nausea medication, and patientreported nausea to each of the following:
type of administration, peak serum levels, and area under concentration time
curves; and (2) assess the difference between measured serum meropenem levels from peripheral blood samples and
percutaneously inserted central venous
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catheters.
Methods: In CF, patients experience
frequent lung infections along with nausea, loss of appetite, and poor absorption
of nutrients. Current treatment for these
infections involves antibiotic therapy, including continuous or intermittent intravenous (IV) infused beta-lactam antibiotics, resulting in additional nausea and
gastrointestinal side effects. A crossover
design will be used for this pilot study to
establish clinical protocols for meropenem administration in pediatric, hospitalized CF patients in order to reduce the incidence of nausea. Patients (N = 10) will
be randomly assigned to 1 of 2 treatment
groups. One group will receive 4 days of
a 120 mg/kg/day continuous IV dose of
meropenem followed by an intermittent
40 mg/kg/dose infused over 30 minutes
every 8 hours for another 4 days. The
other group will receive the intermittent dose followed by the continuous
infusion. Serum concentrations will be
quantified utilizing a high-performance
liquid chromatography instrument, and
incidence of nausea will be measured
through the average doses of granisetron
(Kytril), ordered for each patient in addition to the number of episodes of emesis.
Results: Institutional review board
approval has been obtained, and training of hospital staff to prepare for data
collection is currently underway. This
study may provide information on the
type of infusion (prolonged or short intermittent) that reduces the side effects of
nausea and result in the creation of established clinical protocols for meropenem
administration in pediatric patients with
CF admitted to the hospital, thereby improving patient quality of life and care.
373—ENGAGEMENT OF COMMUNITY PHARMACISTS’ IN TRANSITIONS OF CARE SERVICES. Eubank
D, Layson-Wolf C, Congdon H, Hose B,
Fulton D, University of Maryland School
of Pharmacy, E-mail: [email protected]
Objective: Community pharmacists
have been an underutilized segment
of the health care system by hospitals
nationwide as they continue to search
for ways to reduce readmission rates.
Medication reconciliation is used as a
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APhA2014 ABSTRACTS
way to identify possible errors in patient
medication regimens during transitions
of care. The primary objectives of this
study are to: (1) determine the extent to
which community pharmacists currently
engage in transitions of care practices, including medication reconciliation activities; (2) identify barriers in the provision
of these services; and (3) evaluate the
utility of a common framework to optimize transitions of care.
Methods: The study population
for this survey will include community
pharmacists in Maryland. A survey will
be distributed by e-mail to community
pharmacists with a link to an online
survey. The survey will be available for
6 weeks with reminder e-mails sent at
2 weeks, 4 weeks, and 4 days prior to
end date to improve survey response
rate. The survey consists of questions
that will gather the following information: practice demographics, exposure
to medication reconciliation, level of
involvement in medication reconciliation, barriers to performing medication
reconciliation, findings from medication
reconciliations identified, and general
perceptions about medication reconciliation. Based on responses, the online
survey will utilize skip logic to represent
only applicable questions. The responses
to the survey will be anonymous. Survey
responses will be entered into an Excel
database for analysis.
Results: Research in progress. Survey will be sent and data collection will
begin after institutional review board approval. It is anticipated that the information obtained will be used to characterize
current practices and help develop a best
practices program that meets the needs
of Maryland hospitals as well as streamlining the process to increase participation by community pharmacists.
374—ESTABLISHING
COMMUNITY PHARMACY RESIDENCY AT
AN INDEPENDENT PHARMACY:
TIME ALLOCATION AND RETURN
ON INVESTMENT. Shugart K, Ziegler
B, South Carolina College of Pharmacy,
Kress D, University of South Carolina,
Connelly L, Medicine Mart Pharmacy of
West Columbia, Brittain K, South Carolina College of Pharmacy, E-mail: brit-
e212 JAPhA | 5 4:2 | M AR/AP R 2014
[email protected]
Objective: This study will assess
time allocation and return on investment
(ROI) for a community pharmacy residency at an independent pharmacy. The
time allocation for predefined categories
was measured for a community pharmacy resident, and the ROI for the first year
of community pharmacy residency at an
independent pharmacy was estimated.
Methods: Dispensing, clinical revenue generating, clinical incidental nonrevenue generating, site training, marketing, site precepting, research, public
health, didactic teaching, professional
meetings, residency meetings, resident
education, and miscellaneous were the
predefined time allocation categories the
pharmacy resident used to consistently
classify time completing residency activities. To determine ROI, the costs of establishing and maintaining the resident
office and site preceptor (owner) time
were included. The costs of the residentinitiated programs were established and
compared with the revenue generated
from each of these programs (immunization service, medication administration service). To establish cost savings
achieved by a pharmacy resident when
completing prescription dispensing requirements, a pharmacist average hourly wage was compared with the resident
hourly wage for the time allocated to dispensing. To establish additional revenue
and benefit generated by the resident, including programs that were not directly
revenue generating, a retrospective-prospective comparison of overall change in
revenue, prescription volume, and financial benchmarks were assessed.
375—EVALUATION OF THE USE OF
DAPTOMYCIN AND LINEZOLID
AT A LARGE UNIVERSITY HOSPITAL. Ojong M, Philadelphia College of
Osteopathic Medicine School of Pharmacy, Prue M, George Washington University Hospital, E-mail: mebangaoj@
pcom.edu
study is to analyze the use of daptomycin and linezolid at a large university
hospital.
Methods: A drug inquiry report
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was utilized to identify inpatients who
received daptomycin, linezolid, and
vancomycin from January 1, 2013 to July
31, 2013. A total of 150 charts of patients
(50 patients each who were treated with
vancomycin, daptomycin, and linezolid)
admitted for skin and soft tissue infections, bacteremia, pneumonia, osteomyelitis, kidney infection, or urinary tract
infection were evaluated for inclusion
in the study. Patients’ profiles were then
accessed and the following data were
collected: demographics (age, sex), cost
of drug, site of infection, whether vancomycin was first utilized in patient, and
drug allergy to vancomycin. Chi-square
and analysis of variance (ANOVA) were
utilized for statistical analysis. The primary endpoint was to evaluate use of
daptomycin and linezolid at this hospital. The secondary endpoint was to evaluate the cost of therapy associated with
the use of daptomycin and linezolid.
Results: The average duration of
therapy for the vancomycin control
group hospital stay was 4.16 days, and
4.06 days and 6.56 days for linezolid and
daptomycin, respectively. An ANOVA
analysis found that the duration of
therapy among the 3 drug treatments
were equal (P = 0.11). For patients on linezolid, a chi-square test found that use
of linezolid prior to vancomycin was
independent of the site of the infection
(P = 0.155329). For daptomycin-treated
patients, a chi-square test also found that
use of daptomycin prior to vancomycin
was independent of the site of infection
(P = 0.403389).
Conclusion: Overall, vancomycin
was not utilized as mainstay therapy,
as recommended by the Infectious Diseases Society of America guidelines. The
use of daptomycin or linezolid, as firstline agent, did not decrease duration of
therapy. The clinical significance of these
effects must be determined in a larger
sample size, long-term evaluation.
376—EXPOSURES TO PHARMACEUTICAL DUST IN PHARMACIES
USING AUTOMATIC DISPENSING
MACHINES. Fent K, Tapp L, CDC/
NIOSH/USPHS, E-mail: [email protected]
Objective: The main objective of this
study was to characterize employees’
APhA2014 ABSTRACTS
exposures and health effects from pharmaceutical dust at 3 pharmacies using
automatic dispensing machines (ADMs).
Methods: Real-time particle monitoring was used to identify tasks that
generated pharmaceutical dust; 72 inhalable dust air samples were collected in
or near the employees’ breathing zones
and 57 air samples were selected for
analysis of lactose, a common excipient
in tablets. The real-time particle monitoring results, observations, and information from employees on the dustiness of
pharmaceuticals were used to select 28
air samples for analysis of specific active
pharmaceutical ingredients (APIs). Medical interviews were conducted with 116
employees at 2 pharmacies.
Results: Pharmaceutical dust was
generated during tasks such as emptying
and refilling ADM canisters. Cleaning
canisters and manual count machines
using compressed air produced the highest peak number concentrations of particles. Employees refilling, cleaning, or
repairing ADM canisters, or hand-filling
prescriptions were exposed to higher
median air concentrations of lactose (5.0–
12 µg/m3) than employees doing other
job tasks (0.04–1.3 µg/m3). Ten APIs
were detected in air, including lisinopril,
levothyroxine, and methotrexate. Three
air concentrations of lisinopril (1.8–2.7
µg/m3) exceeded the lower bound of
the manufacturer’s hazard control band
(1–10 µg/m3). All other API air concentrations were below applicable occupational exposure limits. More than 35% of
the interviewed employees reported mucous membrane irritation, which could
be caused by occupational factors such
as pharmaceutical dust exposure as well
as non-occupational factors.
Conclusion: These findings indicate that pharmacy employees could
be exposed to multiple APIs. Potential
health effects from the exposures are not
well understood but could include mucous membrane irritation. Measures are
needed to control these exposures and
thereby minimize the potential for adverse health effects.
377—IDENTIFYING
PERFORMANCE BEHAVIORS AND EXPECTATIONS OF PRACTICE-BASED
RESEARCH NETWORK CLINICIAN
MEMBERS. Patterson B, Stoner S, University of Iowa, Doucette W, University
of Iowa College of Pharmacy, Levy B,
Carter B, Urmie J, Schroeder M, University of Iowa, E-mail: brandon-patterson@
uiowa.edu
Objective: Practice-based research
networks (PBRNs) are opportunities
for health care professionals, including
pharmacists, to participate in knowledge
creation focused on improving health
care delivery and outcomes for realworld patients. PBRNs are diverse and
complex organizations dependent upon
committed and productive clinician
members participating in all research
stages, from conceptualization to dissemination. Currently, no tools exist that
can help PBRN directors evaluate the
performance of their members, which
is critical for developing productive
practice-based research partners. The
objective of this study was to identify expected and experienced PBRN clinician
member performance behaviors.
Methods: As part of a larger study on
leadership and performance in PBRNs,
32 semi-structured interviews were conducted with 16 PBRN directors and 16
non-director participants (e.g., clinician
members) selected using a maximum
variation strategy. Interview questions
addressed performance expectations as
well as positive and negative critical incidents experienced with clinician members while completing PBRN projects.
Interview questions were piloted with
experienced PBRN directors and participants from 2 PBRNs. After transcription,
interview data were randomized. Two
researchers used a systematic behavioral
item coding process that evaluated both
content validity and reliability of their
analysis. Disagreements were resolved
and performance domains were identified through a consensus-forming process involving both researchers.
Results: PBRN clinician member
performance was discussed in 30 of 32
interviews, which averaged 26 minutes.
Twenty-two behavioral item codes were
generated. Content validity and reliability of item generation were statistically
demonstrated. A consensus process was
used to identify 4 performance domains:
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commitment, leadership, awareness,
and communication, within the data that
were face validated by 2 experienced
PBRN directors.
Conclusion: Evaluation of clinician
member performance within a PBRN
should focus on commitment, leadership, awareness, and communication.
Future research should evaluate factors
contributing to increased performance,
which would be valuable to PBRN directors interested in developing clinician
practice research partners.
378—IMPACT OF A TRANSITIONS
OF CARE TRAINING MODULE ON
COMMUNITY
PHARMACISTS’
KNOWLEDGE AND ATTITUDES.
Powers M, Azzi A, Lengel A, Mangan
M, University of Toledo, E-mail: andrew.
[email protected]
study are to: (1) develop a transitions
of care training module for community
pharmacists; and (2) assess the training
impact of the training module on pharmacists’ transition of care knowledge
and their attitude toward actively participating in the transition of care for their
patients.
Methods: The Affordable Care Act
mandated in the 2013 fiscal year that
up to 1% of Medicare payments may be
withheld due to excessive 30-day hospital readmission rates for 3 conditions.
In fiscal years 2014 and 2015, Medicare
payments may be withheld increasingly,
with 4 more conditions being monitored
in 2015. Nationally, two-thirds of all eligible hospitals were penalized in 2013
based on excessive 30-day readmission
rates for a total of $280 million. The ease
of patient access and medication history situates community pharmacists
to have a significant impact in the transitional care of patients. The purpose of
this study is to prepare community pharmacists to provide transitional care for
their patients post discharge. The study
sample will be composed of pharmacists
employed by a supermarket pharmacy
chain. Volunteer participating pharmacists will attend an approximately 2-hour
transition of care educational session.
Participants will complete a pre- and
post-survey immediately prior to and
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APhA2014 ABSTRACTS
following the educational session, in addition to a course evaluation. The survey
will be used to assess the impact of the
educational session on pharmacists’ ability to participate in a transition of care
program. The attitude assessment will
consist of a 5-point Likert scale format
with the knowledge-based assessment
composed of true/false and multiplechoice questions. SPSS version 21.0 will
be used to generate descriptive and
nonparametric statistical analyses. This
study has been submitted for approval
by the university’s institutional review
board.
379—A MULTIDISCIPLINARY INTERVENTION FOR REDUCING
READMISSIONS AMONG OLDER
ADULTS IN A PATIENT-CENTERED
MEDICAL HOME. Remington T, University of Michigan Health System and
College of Pharmacy, Stranges P, St.
Louis College of Pharmacy, Marshall V,
Walker P, University of Michigan, Hall
K, Griffith D, University of Michigan
Health System, Guhad A, University of
Michigan, E-mail: [email protected]
study was to assess the impact of a multidisciplinary transitions of care (TOC)
intervention on rehospitalization rates
among older adults.
Methods: This was a case-controlled, retrospective cohort study of a
TOC intervention based in a patient-centered medical home providing primary
care to geriatrics patients. Patients ≥60
years of age who were discharged from
a large academic hospital and received
care in the health system’s outpatient
clinics were included; 197 patients who
received the TOC intervention were
compared with 985 matched controls
who received “usual care” in other clinics. The primary outcome was all-cause
30-day rehospitalization rates. Logistic
regression was used to test the effect of
covariates on the study outcome and
adjusted for possible confounders in
matched subjects.
Results: Rehospitalization rate was
lower among patients receiving TOC intervention compared with matched controls (11.7% vs. 21.9%, P = 0.01). Further
e214 JAPhA | 5 4:2 | M AR/AP R 2014
analysis demonstrated lower rehospitalization rate among patients who had
a pharmacist included in the TOC interdisciplinary team, compared with those
who did not have a pharmacist included
(11.7% vs. 21.3%, P = 0.006).
Conclusion: A clinic-based TOC
intervention targeting older adults can
substantially reduce rehospitalizations,
with attendant costs and morbidity.
Pharmacists can contribute through care
management, medication reconciliation,
and comprehensive medication reviews.
380—N-ACETYL
CYSTEINE
BLUNTS IMPACT OF PROTEASOME
INHIBITION IN A GLUTATHIONEINDEPENDENT MANNER. Jiang E,
Duquesne University, Rumble J, Penn
State University, Unnithan A, Pulugulla
S, Choi H, Posimo J, Titler A, Leak R,
Duquesne University, E-mail: asu3201@
live.com
Objective: N-acetyl cysteine (NAC)
has been shown to improve cognition in
patients with Alzheimer’s disease and to
prevent the neurological symptoms of
blast injury in soldiers during combat.
NAC is also used in some psychiatric
conditions. Most studies assume that
NAC works by raising the antioxidant
glutathione. However, NAC was observed to raise heat shock protein 70
(Hsp70) levels in neuronal cells treated
with the proteasome inhibitor MG132.
MG132 prevents the proteasomal degradation of misfolded proteins that are
tagged with a ubiquitin tail and is frequently used in cellular models of neurodegeneration. Hsp70 helps refold misfolded proteins and guides ubiquitinated
proteins to the proteasome for clearance.
The present study therefore tests the hypothesis NAC protects neuronal cells by
facilitating the Hsp70 response to stress.
Methods: Neuroblastoma N2a cells
were treated with NAC and the peptide
aldehyde MG132, a reversible inhibitor
of proteasomal degradation of misfolded
proteins. Hsp70 ATPase activity was inhibited with the compound VER155008.
Viability was assessed by 3 independent
and unbiased assays: (1) an ATP assay
(Cell Titer Glo) and (2) by staining for the
cytoskeletal protein alpha-tubulin or (3)
for the nucleus and cytoplasm with inja p h a .org
frared DRAQ5 + Sapphire.
Results: NAC shifted the MG132
dose-response curves to the right in all 3
assays, confirming that NAC protected
N2a cells against MG132 toxicity. NAC
increased Hsp70 levels in MG132-treated
cells and attenuated MG132-induced increases in misfolded, ubiquitinated proteins. No parallel change was elicited in
heat shock cognate 70 (Hsc70), a closely
related member of the heat shock protein
family. Inhibition of Hsp70 activity with
VER155008 attenuated the protection
afforded by NAC in a dose-responsive
manner. VER155008 also prevented the
reduction in ubiquitinated proteins by
NAC. These data reveal that NAC can
no longer reduce levels of misfolded proteins or protect N2a cells from MG132
toxicity when Hsp70 activity is inhibited.
Conclusion: NAC protects neuronal
N2a cells from proteasome inhibition
by raising the Hsp70 chaperone protein. Proteasome inhibition is relevant
to neurodegenerative disorders because
protein-misfolding stress is a central
feature of these conditions. If findings of
this study can be generalized to the human brain, they may explain why NAC
was effective in multiple double-blind,
placebo-controlled clinical trials. These
findings therefore broaden the potential mechanisms of action of this dietary
supplement.
381—NANOTECHNOLOGY
FOR
TOXICOLOGY: PRELIMINARY RESULTS OF IN VITRO ADSORPTION
STUDIES COMPARING HALLOYSITE NANOTUBES TO ACTIVATED
CHARCOAL. Israel M, University of
Louisiana Monroe, Weisman J, Louisiana Tech University, Khaled K, Louisiana State University, Mills D, Louisiana
Tech University, E-mail: [email protected]
Objective: Overdose of toxic compounds can be treated with activated
charcoal or chelating agents. Activated
charcoal does not adsorb heavy metals
well or certain charged molecules. Currently, there are few studies looking at
using nanotechnology for toxicology.
Halloysite clay nanotubes are biocompatible aluminum silicate tubes that
average a 15 nanometer diameter and
APhA2014 ABSTRACTS
large lumen surface area. Halloysite
nanotubes are naturally occurring clay
deposits that are affordably mined. The
purpose of this study is to determine
whether nanotechnology such as halloysite nanotubes could adsorb substances
comparably to activated charcoal.
Methods: A 1 mg/mL solution of
boric acid was created to act as a solution of interest. Boric acid was chosen
as a substrate for preliminary studies
due to size, previous spectrophotometry
work, and cost. Then 1 mL of this boric
acid solution was placed into 2 sets of 5
test tubes. Each set of test tubes had a 1
mL solution of boric acid per tube then
5 mg, 10 mg, 25 mg, 50 mg, or 100 mg of
either halloysite nanotubes or activated
charcoal were added. The test tubes
were vortexed then placed on a shaker.
After 1 hour, a sample was drawn from
each tube to determine the level of boric
acid remaining in the supernatant via
spectrophotometry. A NanoDrop spectrophotometer was used at the 260 nm
wavelength of light. The resulting absorbance of light and concentrations of the
remaining substrate was recorded and
charted for comparison.
Results: Research in progress. Halloysite adsorbed solution depending
upon halloysite concentration. Activated
charcoal samples were able to adsorb, although not as well as activated charcoal
normally adsorbs. A gram of halloysite
has a surface area in excess of 69 square
meters and activated charcoal has in excess of 500 square meters. The completed
data set will compare these compounds.
382 — PH A R M AC IST-PROV IDED
MEDICATION
MANAGEMENT
SERVICES IN TRANSFORMATIONAL PRIMARY CARE PRACTICES.
Smith M, University of Connecticut
School of Pharmacy, E-mail: marie.
[email protected]
study are to: (1) describe the type and
extent of pharmacist-provided medication management services (MMS) in the
Center for Medicare and Medicaid Innovation Comprehensive Primary Care
(CPC) program; (2) compare the pharmacist and physician leader responses
about CPC MMS to identify any percep-
tion “gaps”; and (3) identify policy implications for scalable and sustainable
primary care MMS.
Methods: A 20-question survey
instrument was developed based on a
comprehensive literature review and
the author’s research with medical
homes and community-based health
care teams. Online surveys will be sent in
October 2013 to a pharmacist and clinical
leader (usually a physician) at each of the
29 CPC practices that included pharmacists on their CPC team. Reminder notices will be sent to all nonrespondents at
1 and 2 weeks after fielding the survey.
The survey will collect pharmacist demographics, type and extent of pharmacist-provided MMS, workflow integration of MMS into primary care practices,
and value of pharmacist-provided MMS.
The online survey software (Qualtrics)
will be used to compile the results. The
study will provide descriptive data for
the pharmacist demographics, and will
identify any perception gaps between
pharmacists and clinician leaders on the
provision, clinical impact, and value of
pharmacist-provided MMS.
Results: Research in progress. Survey will be fielded in October 2013 with
final results compiled in November 2013.
The implications are: (1) better description of pharmacist-provided MMS in
innovative, national health care transformation programs; (2) Centers for Medicare and Medicaid–supported program
with high national visibility can scale
pharmacist-provided MMS; (3) multiple
payers (Medicare, Medicaid, and several commercial plans) involved in the
CPC program can be informed about the
value of pharmacist-provided MMS for
payment policy changes.
383—PHARMACISTS
MAKE
HOUSE CALLS? A DESCRIPTION
OF AN INNOVATIVE COMMUNITY
PHARMACY PRACTICE MODEL.
Passafiume S, Brody Jr. P, University at
Buffalo, Comerford Jr. P, Trzewieczynski
D, Andrus Jr. K, Mobile Pharmacy Solutions, Monte S, University at Buffalo, Email: [email protected]
Objective: This project aims to describe innovative services provided by
community pharmacists, with an em-
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phasis on the home visit component of a
unique practice model.
Methods: Ten innovative services
have been implemented by pharmacists
at a community pharmacy in Buffalo,
New York. The services are as follows:
inbound phone call triage to a clinical
pharmacist–managed hub; outbound
adherence phone calls linked to home
delivery scheduling; medication refill
synchronization and customized adherence packaging; extemporaneous compounding; certified public accountant–
managed patient accounts receivable;
free home delivery with an option for
mailing or personal courier; pharmacist
home visit; community pharmacist liaison; utilization of an electronic medical records interface; and a 24/7 on-call
pharmacist. The study cohort will be
drawn from a population of patients
who received home visit services during
the study period of August 2012 through
August 2013. The following information
will be collected for each patient: age,
sex, insurance type, referral source, zip
code, chronic medications, and chronic
disease states. Data on travel time and
pharmacist preparation time also will
be collected. This study will describe the
types of patients visited, the types of referrals, as well as the time and financial
expense associated with sending pharmacists to the patient’s home. Evidence
that home visits are adaptable into a
community pharmacy practice model
is critical for expanding the role of the
pharmacist in evolving health care paradigms and moving toward sustainment
of new payment sources for community
pharmacy.
AWARENESS AND SELF-EFFICACY OF RESOURCES AVAILABLE FOR SPANISH-SPEAKING PATIENTS. Devraj
R, Marchello A, Southern Illinois University–Edwardsville, Pearson, Jr. M, Walgreens, E-mail: [email protected]
Objective: Hispanics, the largest
minority group in the United States,
face challenges communicating with
pharmacists, negatively impacting their
medication use and outcomes. Evidence is lacking regarding pharmacists’
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APhA2014 ABSTRACTS
knowledge about available resources to
communicate with Spanish-speaking
patients. The study objectives were to: (1)
determine Illinois pharmacists’ knowledge about types of Spanish-speaking resources (SSR); (2) determine frequency,
accessibility, and usefulness of available
SSR; and (3) determine pharmacists’ selfefficacy in handling Spanish-speaking
patients.
Methods: A survey addressing the
study objectives was designed and pilottested with 10 community pharmacists.
The final survey, currently administered
over the phone, consists of items addressing: (a) types of available SSR, including
how often, easy, and helpful they were;
(b) pharmacists’ self-efficacy in handling
Spanish-speaking patients, determined
using a previously validated 9-item instrument; and (c) demographics. Items
enquiring about how often, easy, and
helpful the resources were belonged to a
5-point scale (1 = never; 5 = always). Using 3 sources (i.e., Superpages.com, Zipcodes.com, and Quickfacts.census.gov)
a random sample of 10% of pharmacies
from counties with low concentrations
of Spanish-speaking patients and 20% of
pharmacies with high concentrations of
Spanish-speaking patients were identified to form the study sample. Data collection is ongoing with more than 80% (n
= 200) of the data collected to date from
the 231 pharmacies that are part of the
study. This study was approved by the
university’s institutional review board
committee. Data will be analyzed using
frequencies, t tests, and chi-squares.
top 3 types of resources available to pharmacists were computer-based resources (91.5%), patients’ family members
(81.4%), and phone help lines (77.4%).
Among the computer-based resources,
computer-generated prescription labels
(mean = 1.94 + 1.50), and leaflets (mean
= 1.89 + 1.42) were used most often, were
easy to use (labels mean = 3.43 + 1.76;
leaflets mean = 3.43 + 1.72), and helpful (mean = 3.49 + 1.82; mean = 3.34 +
1.85). Self-efficacy item means ranged
from 2.74 + 1.36 to 3.87 + 1.29 based on a
5-point scale (1 = not at all confident; 5 =
extremely confident).
e216 JAPhA | 5 4:2 | M AR/AP R 2014
385—PHARMACY PRACTICE MODEL TO ADVANCE THE HEALTH
AND WELL-BEING OF PATIENTS.
Thompson B, Hennepin County Medical Center, E-mail: bruce.thompson@
hcmed.org
Objective: The primary objectives
are to improve the health of patients by
decreasing the 30-day readmission rate,
reducing preventable adverse events,
and reducing the cost of care. This is accomplished by maximizing the use of
pharmacists during the transitions of
care.
Methods: Initial work with a pharmacist-driven discharge medication reconciliation model for patients transferred
to skilled nursing facilities (SNF) was followed up with a total care model in a controlled patient population with capitated
payments much like an accountable care
organization (ACO) model. Pharmacy
worked with the hospital and clinics to
further enhance the medical home model
to focus on patient health. Pharmacists
provide discharge medication reconciliation and patient follow-up within 3 to
5 days post-discharge with medication
therapy management (MTM) visits. Patients in the population who were high
risk for hospitalizations were identified
and MTM visits were arranged, which
proved valuable in reducing total health
care expenses. Pharmacy worked on
patients’ behalf to provide medications
when financial barriers exist.
Results: The SNF patient 30-day readmission rate decreased by more than
40% when pharmacists provided discharge medication reconciliation from
the hospital while essentially eliminating preventable adverse medication
events. The reductions in readmissions
have been sustained for the past 4 years.
The ACO model reduced emergency
department visits by 37% and hospitalizations by 42% thus saving approximately $2,500 per patient annually in this
8,000-patient cohort.
Conclusion: Pharmacy has improved and expanded services to benefit
the medical center’s patients, improve
safety, and improve quality in this health
system. The use of pharmacy personnel
has been maximized to allow pharmacists additional time to provide patient
ja p h a .org
care. This transition of care model has
shown to provide value to patients, be financially viable, sustainable for the past
4 years, and transferable to other health
systems.
386—PHARMACY
STUDENTS
HELP LAUNCH THE CONNECTICUT HEALTH INSURANCE MARKETPLACE. Kirchhoff K, Wang J,
Sounthonevat C, Smith M, Tyczkowski
P, University of Connecticut School of
Pharmacy, E-mail: marie.smith@uconn.
edu
Objective: This project aimed to: (1)
create summer internships for doctor of
pharmacy (PharmD) students with the
Connecticut Health Insurance Marketplace (CTIM); (2) assist the CTIM with
statewide implementation of a health
care marketplace as part of the Affordable Care Act (ACA); and (3) train
PharmD students to provide in-person
assistance to help people choose the best
individual or family health care plan.
Methods: Pharmacy faculty met
with CTIM leaders to create a paid summer internship program for PharmD
students. Interns launched the outreach
and enrollment campaign for the CTIM.
Students developed field-testing scripts
for outreach workers and in-person assistors (navigators), collected data on
uninsured populations to determine
high-density regions of Connecticut, and
created a visual image of the state’s uninsured population. Interns also organized
outreach activities throughout the state
including festivals, concerts, and storefronts to advocate and educate consumers about ACA and CTIM. Student pharmacist organizations were contacted to
participate in the CTIM grant program to
train in-person assistors to help Connecticut residents enroll in a health care plan.
Results: During summer 2013, 3
PharmD students worked full-time for
10 weeks on multiple outreach activities.
They talked to 5,480 individuals and collected lead generation information for
400 individuals. Consumer interest and
lead generation was higher when opening questions to engage consumers about
ACA or CTIM were as follows: “Have
you heard of the tax penalties in 2014
if you do not have health insurance?”
APhA2014 ABSTRACTS
and “Did you know you might save on
health insurance with just 2 minutes of
your time?” The CTIM in-person assistor training program was completed by
9 PharmD students, resulting in $18,000
for student pharmacist organizations.
Conclusion: Pharmacy school faculty and students can be active participants
in health care advocacy and reform. As
accessible health care professionals,
pharmacists should anticipate patient
questions about ACA as well as the
state and federal insurance marketplace.
Pharmacists and PharmD students can
be trained as in-person assistors to facilitate the consumer enrollment into health
care plans.
387—PHYSICIANS’
VIEWS
OF
COMMUNITY PHARMACY EMERGENCY SUPPLY/REFILL DISPENSING PRACTICES. Noureldin M, Purdue University, DeJager M, Target, Myers J, Plake K, Purdue University, E-mail:
[email protected]
explore physicians’ views of community
pharmacy prescription medication lending practices (also known as emergency
supply/refill dispensing).
Methods: Five hundred physicians
were randomly selected from the Indiana Medical Licensing Board database
and sent a 25-item mail survey. Data
were collected from October to December 2012. The survey explored physicians’ views of pharmacists’ lending of
10 different prescription medications
to patients on Monday and Saturday
evenings as well as physicians’ views
toward medication lending based on
patients’ duration of therapy (<1 month,
1–3 months, >3 months, >6 months).
A 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) was used to
assess level of agreement with each statement. A demographic section included
sex, age, race/ethnicity, specialty practice, and physicians’ previous awareness of medication lending. Descriptive
statistics and nonparametric tests were
performed.
Results: A total 114 physicians completed the survey (response rate 22.8%);
68% of respondents were male, 75.9%
were white, and 22.1% identified family
medicine as their specialty. Fifty-eight
percent of respondents were previously
unaware of lending practices. Physicians agreed (>70% strongly agreed or
agreed) with pharmacists’ emergency
lending of phenytoin, albuterol, and
clopidogrel; disagreed (>70% strongly
disagreed or disagreed) with lending of
hydrocodone/acetaminophen,
zolpidem, or sildenafil; and respondents were
split (40%–60% agreement) on lending
rosuvastatin, sumatriptan, escitalopram,
and ethinyl estradiol/drospirenone.
For 9 out of 10 medications, physicians’
agreement with lending increased for
Saturday compared with Monday evening (P<0.05). There also was a trend of
increased agreement toward lending
medications with increased duration of
therapy.
Conclusion: The majority of physicians were unaware of prescription medication lending in community pharmacies and had mixed opinions regarding
this practice. Medication lending/emergency refill dispensing is an accepted but
unexplored practice in community pharmacies. Additional studies may shed
light on its prevalence, attitudes toward
medication lending, and its impact on
patient care.
Q 388—REDUCING THE RISK OF
INADEQUATE SEDATION DURING
RAPID SEQUENCE INTUBATION
IN THE EMERGENCY DEPARTMENT SETTING. Nengchu P, Tripler
Army Medical Center, E-mail: [email protected]
study is to reduce the risk of inadequate
sedation during rapid sequence intubation in the emergency department (ED).
Methods: The emergency department (ED) clinical pharmacist identified
variation in drug selection and timing
during rapid sequence intubation (RSI).
A retrospective chart review showed
that post-intubation sedation was sometimes omitted or delayed. Factors such
as drug selection, sequence timing, and
post-intubation sedation issues were
recorded for each encounter. A 1-year
pharmacy education initiative focused
on nursing and provider staff. A mandatory lecture available by compact disc
j apha.org
and an RSI quiz was administered to all
nursing staff. Educational lectures about
the RSI drug selection and timing issues
identified at the medical center were
given to both nursing and provider staff.
After the education initiative was complete, 100% of patients who underwent
RSI were identified and included in a
3-month post-education initiative chart
review.
Results: The pre-initiative chart review revealed that 18% of patients did
not receive any sedatives post-intubation
and 15% of patients possibly had paralysis without sedation based on the timing
of drug administration. After the education initiative by the ED pharmacist,
variability in drug selection decreased.
Only 1 patient did not receive a sedative
post-intubation due to immediate transfer of care and no patients possibly had
paralysis without sedation based on the
timing of drug administration.
Conclusion: Education initiatives by
the ED pharmacist can improve the timing and selection of drugs utilized in RSI
to improve patient safety and comfort in
the ED. [The views expressed in this publication/presentation are those of the
author(s) and do not reflect the official
policy or position of the Department of
the Army, Department of Defense, or the
U.S. Government.]
Original Citation: Reducing the risk
of inadequate sedation during rapid sequence intubation in the emergency department setting.
389—REVIEW OF HEADACHE AND
MIGRAINE-RELATED
APPLICATIONS AVAILABLE FOR SMARTPHONES. Murray K, O’Neal K, Lamb
M, Carter S, University of Oklahoma
College of Pharmacy, E-mail: [email protected]
Objective: Evidence suggests that
educational tools may be beneficial to
migraineurs to manage their condition
and help to ameliorate the severity of
their disease. This study aims to: (1) identify migraine-related applications available for smartphones; and (2) categorize
the content of these applications according to the following criteria: background
information, consumer ratings, technical
capability, and patient-focused criteria
MA R /APR 2014 | 54:2 |
JAPhA e217
APhA2014 ABSTRACTS
based on the available description of the
application from the seller.
Methods: This study utilizes content analysis in a cross-sectional design
to systematically categorize product
descriptions of migraine-related applications advertised in the iTunes application “store” using the search terms
migraine and headache. Two clinical
pharmacists will search for applications
during a specified time window and enter content in the data abstraction form,
following their training by the project
investigator on operational definitions,
coding, and other information on content analysis procedures. Open-ended
data will be coded and viewed by an additional rater for agreement on coding
categories. Coding will be based on majority rule. kappa statistics will be used
to discern inter-rater reliability. Descriptive statistics will be used to address the
study objectives. Applications deemed
unrelated to migraines by reviewer consensus will be excluded from analysis.
piloting of this study is complete and the
data abstraction tool has been finalized.
A full review of available migraine-related applications for smartphones using
these search terms identified 227 applications, including those that appeared in
both search term results. Final data procurement and data analysis of abstracted
variables will occur until January 2014.
The evidence from this study is intended to help describe the type of applications available for use by patients with
migraines and headaches and provide
clinicians with more information about
which applications offer certain specific
and relevant features.
390—STUDENT
PHARMACISTS’
INVOLVEMENT IN LEADERSHIP
ROLES. Lloyd A, Elmore L, Samford
Objective: Student leadership within pharmacy school is highly encouraged, and it may aid students in differentiating themselves from their classmates.
Volunteerism also may enhance effective
communication, peer collaboration, and
strategic planning. The purpose of this
cross-sectional study was to: (1) quantify
students serving in leadership positions;
e218 JAPhA | 5 4:2 | M AR/AP R 2014
(2) determine how satisfied students are
with their pharmacy education; and (3)
determine whether they desire additional leadership opportunities.
Methods: Following institutional review board approval, an adapted version
of a previously validated, 24-question
survey with quantitative and qualitative
questions was distributed to first-, second-, and third-year pharmacy students
before class by the student researcher.
Students were informed that this survey
was anonymous and participation was
voluntary. Survey items assessed student involvement, grade point average
(GPA), and desired level of involvement.
Results: The survey was completed
by 209 students: 65 students (56.5%) from
the first-year class, 66 students (52.8%)
from the second-year class, and 78 students (65.3%) from the third-year class.
Qualitative analysis revealed that 48%
of students held at least 1 leadership role
within the school; 32% of those students
held 2 leadership positions; 15% held 3
positions; and 0.2% held 5 positions. Fifty-four percent of students were satisfied
with their GPA (self-reported), and 72%
of respondents were satisfied with their
overall experience in pharmacy school.
Sixty-eight percent of students said they
would be more involved within extracurricular activities given an ideal situation (enough time, money, etc.).
Conclusion: Data show that half of
the students have some leadership position. This may reveal a need for education early in the curriculum that will aid
students in selecting the most appropriate leadership opportunities. Given
that students desire to hold additional
leadership opportunities, the number
of leadership opportunities within the
school may be expanded.
Q 391—USE OF APIXABAN AND
WARFARIN IN PATIENTS UNDERGOING INVASIVE PROCEDURES:
INSIGHTS FROM ARISTOTLE.
Lopes R, Duke University Medical Center, Garcia D, University of Washington,
Wojdyla D, Duke Clinical Research Institute, Dorian P, St. Michael’s Hospital,
The University of Toronto, Alexander J,
Duke University Medical Center, Wallentin L, Uppsala University, Lanas F,
ja p h a .org
Universidad de La Frontera, Hanna M,
Bristol-Myers Squibb, Held C, claes.
[email protected], Department of Medical Sciences, Cardiology and Clinical
Research Center Granger, Co-Author,
Duke University Medical Center Cardiac
Care Unit, Department of Cardiology, Email: [email protected]
is to investigate rates of invasive procedures among patients in the ARISTOTLE (Apixaban for Reduction in Stroke
and Other Thromboembolic Events in
Atrial Fibrillation) trial as well as the risk
of stroke and major bleeding following
invasive procedures. The risk of stroke
or systemic embolism (SSE) associated
with stopping warfarin for invasive
procedures is thought to be low. Little
is known about apixaban use in patients
undergoing invasive procedures.
Methods: Using data from 18,201
patients in ARISTOTLE (median followup 1.8 years), this study described the
most common invasive procedures, use
of bridging therapy, and risk of stroke
and major bleeding during the 30 days
following these procedures. Procedures
were classified as major if they required
general anesthesia or were considered to
pose a significant postoperative bleeding
risk. Investigators classified procedures
as emergent or nonemergent.
Results: There were 11,417 invasive
procedures performed in 6,162 patients:
477 (4.2%) were major and 10,940 (95.8%)
nonmajor; 322 (2.8%) were emergent
and 11,095 (97.2%) nonemergent. The
most common procedures were dental
extraction/oral surgery, colonoscopy,
upper endoscopy, and ophthalmic surgery. In 4,082 procedures (35.8%), study
drug was not stopped. Median time of
study drug stop was 4 days before the
procedure for both apixaban- and warfarin-treated patients. A second bridging anticoagulant, most commonly lowmolecular-weight heparin, was used in
1,335 procedures (11.7%). Of 5,660 events
in the apixaban group, 0.43% were associated with SSE and 1.55% with major
bleeding. Of 5,757 events in the warfarin
group, 0.56% were associated with SSE
and 1.80% with major bleeding.
Conclusion: Invasive procedures
are common in patients with atrial fibril-
APhA2014 ABSTRACTS
lation. Most procedures are nonmajor
and nonemergent, and anticoagulation
therapy is likely to be stopped periprocedure. Overall and among emergent
procedures, rates of clinical events in the
first 30 days post-procedure were low
and comparable between patients receiving warfarin and apixaban.
Original Citation: Lopes RD, Garcia
DA, Wojdyla D, Dorian P, Alexander JH,
Wallentin L, Lanas F, Hanna M, Held C,
Granger CB. Use of apixaban and warfarin in patients undergoing invasive
procedures: insights from ARISTOTLE.
Presented at: Annual congress of the
European Society of Cardiology; August 31-September 4, 2013; Amsterdam,
Netherlands. Eur Heart J. 2013;34(suppl):98-99.
392—VALIDITY OF CARDIOVASCULAR RISK PREDICTION MODELS IN KIDNEY TRANSPLANT
RECIPIENTS: A SYSTEMATIC REVIEW. Mansell H, Stewart S, Shoker
A, University of Saskatchewan, E-mail:
[email protected]
Objective: The objective of this systematic review was to assess the validity
of cardiovascular risk prediction models
in kidney transplant recipients. Pharmacists can play a role in cardiovascular risk
assessment within the community or as
part of the transplant team. Cardiovascular disease is the leading cause of mortality in kidney transplant recipients and although evidence is lacking, risk-scoring
methods used in the general public are
often applied to this population.
Methods: The protocol was registered in Prospero, an international database of prospectively registered systematic reviews in health and social care.
Five databases (MEDLINE, EMBASE,
SCOPUS, CINAHL, and Web of Science)
were searched and 2 investigators independently reviewed the abstracts. Cohort studies involving the ability of a risk
scoring system to identify cardiovascular events in renal transplant recipients,
with at least 1 year of follow-up were
included. Data extraction included variables that described population characteristics, study design, and prognostic
performance. Risk of bias was evaluated
using the QUIPS tool.
Results: Seven studies met criteria
for inclusion: 5 investigated the Fram-
j apha.org
ingham risk score; 3 used a transplantspecific model; and 2 utilized a 7-year
risk major adverse events calculator.
Sample sizes ranged from 344 to 23,575,
and 3 studies lacked sufficient event
rates to confidently reach conclusion.
Potential for bias was present in all the
papers, though only 1 manuscript had
significant bias. Four studies reported
discrimination (as measured by c statistic), which ranged from 0.701 to 0.75, and
only 1 risk model was both internally
and externally validated in kidney transplant recipients.
Conclusion: While the Framingham has underestimated cardiovascular events in renal transplant recipients,
these studies have not been robust. Recently, a transplant-specific risk prediction model has been externally validated.
Comprehensive validation in multiple
cohorts and impact analysis is recommended, however, before widespread
clinical application is advocated by pharmacists and other health professionals.
MA R /APR 2014 | 54:2 |
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APhA2014 ABSTRACTS Adherence and Persistence

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