INNOVATIONS in pharmacy (Iip - E-Journal)
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How Can Pharmacists Support STI Prevention and Treatment Among Female Adolescents and Young Adults?
Get PDFSexual and reproductive health is a critical focus area for adolescents and young adults (AYAs). Of the 20 million newly diagnosed Sexually Transmitted Infections (STIs) annually, nearly half of them are contracted by young people between the ages of 15 to 24. It has become increasingly necessary to improve awareness and prevention of STIs during adolescent years. The knowledge gained through appropriately relevant sexual and reproductive health education may persist as adolescents transition into adulthood. Community pharmacists interact with AYAs frequently and are therefore well positioned to engage this vulnerable population in conversations about their sexual and reproductive health through use innovative and interactive technologies. For instance, mobile applications are easily accessible to AYAs and can allow pharmacists to disseminate relevant medication information to smartphone users that download adolescent-tailored mobile applications. Although many medication adherence apps are currently available on the market, none of these apps are tailored towards sexual reproductive health information for female AYAs. A mobile-based program designed to provide a pharmacist-guided sexual and reproductive health education to female AYAs may help to address the lapses in current adolescent-aged school health classes. In the future, usage of this intervention would improve the accuracy and comprehension of female adolescents and young adults’ awareness and knowledge of their sexual and reproductive health. As a result, further research should be conducted to develop mobile applications conducive to adolescent and young adults to address sexual and reproductive health issues.
Conflict of Interest
We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.
Type: Idea Pape
More Imaginary Worlds: A Systematic Review of the Status of Modeled Cost-Effectiveness Claims Published in the Journal of Medical Economics from January 2016 to December 2016
Get PDFIn 2016 a review of modeled cost-effectiveness studies published in the Journal of Medical Economics between January 2015 and December 2015 was presented in INNOVATIONS in Pharmacy. The purpose of this review, together with similar reviews for studies published in calendar 2015 in Value in Health and Pharmacoeconomics, was to consider whether these modeled claims for cost-effectiveness met the standards of normal science: were the claims made credible, evaluable and replicable? A total of 32 studies were identified. None of the studies presented their claims or projections in an evaluable form and none suggested how they might be evaluated. None met the standards of normal science. The claims made for cost-effectiveness were either impossible to verify, or if potentially verifiable, were not presented in an evaluable form. The studies lacked credibility. There was no basis for assessing whether the claims were right or even if they were wrong. The purpose of the present review which covers cost-effectiveness studies published in the Journal of Medical Economics between January 2016 and December 2016 is to revisit this question of the credibility of the claims made against the standards of normal science. A total of 40 cost-effectiveness studies were identified. Although 14 had a timeframe of 5 years or less and hand the potential to provide short-term evaluable claims, none addressed the issue of claims evaluation and the possible protocols that would support empirical assessment. Of the balance, 19 presented results as unevaluable lifetime modeled claims. The conclusions from the 2016 review remain unchanged.
Type: Commentar
Promoting Peer Debate in Pursuit of Moral Reasoning Competencies Development: Spotlight on Educational Intervention Design
Get PDFResearch indicates that appropriately designed educational interventions may impact positively on moral reasoning competencies development (MRCD) as measured by a psychometric measure known as the Defining Issues Test (DIT). However, findings include that educational interventions intended to impact on MRCD do not consistently promote measurable pre-post development. This paper reviews the theoretical background to the use of educational interventions to impact on MRCD, and spotlights how underpinning Neo-Kohlbergian theory might inform the design of an intervention in order to optimise impact on MRCD.
Findings indicate that peer debate - regarding ethical concepts in profession-specific dilemma scenarios, what action(s) might be taken and how ‘less than ideal’ action options might be justified - is essential. Five examples of an adapted format of ‘Neo-Kohlbergian’ profession-specific ‘intermediate concept measures’ (ICMs) are included and were integrated into a 16 week blended learning educational intervention in a manner that promoted repeated exposure to peer debate regarding dilemmas, and the educational intervention design was trialled in a study with 27 volunteer community pharmacists in Ireland. An overview of the design, development and delivery of the intervention is provided. The paper concludes with recommendations for further development of the ‘idea’.
Conflict of Interest: None
Type: Idea Pape
Resolving Lingering Problems or Continued Support for Pseudoscience? The ICER Value Assessment Update
Get PDFThe Institute for Clinical and Economic Review (ICER) released its updated value assessment framework in mid-2017. This included refinements to its conceptual structure and modifications to methods of collecting and assessing evidence. Consequent to this release, a number of authors have commented on the updated value framework, addressing the question of whether the latest framework represents a major revision or merely attempts to resolve lingering problems. The purpose of this commentary is twofold: (i) to revisit what are considered to be fundamental flaws in the ICER value assessment framework and (ii) to question whether or not post-release critiques of the value framework address the fundamental weaknesses in the ICER approach: the absence of credible, evaluable and replicable claims for the benefits and harms of a therapy intervention. The commentary argues that while ICER sees the purpose of its value assessment framework as forming ‘the backbone of rigorous, transparent evidence reports’ in placing ‘scientific methods of evidence analysis at the heart of a clearer and more transparent process’ it falls far short of these ideals. Rather, in attempting to replicate in the US health care environment the evaluation framework mandated by the National Institute for Health and Care Excellence (NICE) in the UK, the ICER falls into the trap of generating value claims for product impact that fail to meet the standards of normal science.
Type: Commentar
A New Conceptualization and Approach to Learning and Teaching Motivational Interviewing
Get PDFType: Idea Pape
Development of Critical Thinking in Pharmacy Education
Get PDFThe concept of development is ubiquitous throughout higher education. Development of critical thinking, problem-solving, and clinical reasoning are noted as important outcomes in higher education, including health professions education. In this era of widening scrutiny, demonstration of this outcome within programmatic assessment is becoming increasingly important. Programmatic assessment of critical thinking is complicated because of its multiple definitions, array of theoretical frameworks, and variety of measurement instruments. Additionally, recent guidelines and standards for pharmacy education have affirmed “habits of mind,” which are not new to education and encompass analytical critical thinking. In this paper, we sought to provide: 1) an overview of various critical thinking measurement instruments with their different associated critical thinking definitions, 2) a background and framework for thinking using the Dimensions of Learning model, 3) implications and applications for assessing cognitive development (critical and complex thinking) within the context of pharmacy education, and 4) specific suggestions for assessment in pharmacy education.
Type: Idea Pape
Development of the Adherence Predictive Index (API) for Medication Taking
Get PDFThe objective for this study was to explore if characteristics of personality type using the Preferred Communication Style Questionnaire, in concert with the demographic characteristics of age, education, and race/ethnicity, are associated with, and help predict, individuals’ medication adherence behavior.
Data were collected via an on-line survey, sent to a sample of adults residing in the United States, between April 28 and June 22, 2015. Out of 26,173 responses to the survey, 16,736 reported taking one or more medications and were eligible for inclusion in this study.
The development of the Adherence Predictive Index (API) used mean Morisky Medication Adherence Scale (MMAS-8) scores for each of eight personality types as a starting point. API scores were calculated by adding or subtracting specific values to each group’s mean MMAS-8 score based on personality type, age, education and race/ethnicity characteristics which were demonstrated to have significant effects on adherence. The weighting system was informed by linear regression, logistic regression, personality type literature, researcher experience, and previous qualitative and quantitative research. The resultant score was converted to an API score that ranged from 1 to 5 so that it would be feasible for health care providers to understand and use.
The findings showed that an Adherence Predictive Index (API) could be developed based upon a relatively small number of questions that focus on personality type and generational, educational, and cultural experiences. It was developed in order to be a component of a comprehensive program that has the goals of (1) identifying and describing specific behavioral strategies individuals are most likely to successfully employ, (2) motivating patients by using their preferred communication style, and (3) predicting each patient’s propensity to adhere. Future research is needed to evaluate the index’s validity, sensitivity, and effectiveness in actual practice compared with other risk indices.
Type: Original Researc
Perceptions of Medicinal Plant Use Amongst the Hispanic Population in the St. Louis Metropolitan Area
Get PDFIntroduction: Medicinal plant use in the United States has increased as reported by the National Center of Complementary and Integrative Health and U.S. Census Bureau.However, little is known about how many minority groups in the United States use medicinal plants.There is a rise in the Hispanic population; a community with a steep tradition of medicinal plant use, in the U.S., so understanding the perceptions of medicinal plant use is useful to healthcare providers.
Methods: A survey was designed to gauge a better understanding of the perceptions of medicinal plant use amongst Latino patients with varying education levels who reside in the St. Louis Metropolitan Area. Survey questions highlighted the perceptions of medicinal plants use, patient communication regarding medicinal plant use with healthcare providers (pharmacists and doctors), and the impact the education level has on medicinal plant use.
Results: Surveys were distributed to six different investigational sites around the St. Louis Metropolitan Area from August 2015 to December 2015. Survey respondents identified 45 different plants/herbs that they currently use or had used at some point in their life. Those with higher levels of education had varying opinions on medicinal plant use with their current practices.
Conclusion: The participants’ high interest in the use of medicinal plants exemplifies the need for enhanced communication between patients and healthcare professionals about medicinal plant use. However, it was hard to determine whether the participants’ level of education had any direct relationship to this use.
Conflict of Interest
None
Type: Original Researc
Pharmacy Practice: Exploring the Relationship between SSRIs and Sodium Levels in an Older Adult Population
Get PDFI was asked to examine the presence of hyponatremia (<130 mEq/L) in older patients (>65 years) taking Selective Serotonin Reuptake Inhibitors (SSRIs) at Moses Cone Hospital. The presence of hyponatremia in older patients using SSRIs indicates potentially inappropriate use according to the STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria6. This study was done to assess possible risk factors for potentially inappropriate use of SSRIs by older patients at Moses Cone Hospital. Data collected included the patient’s sex, age, sodium level, and the date the sodium level was drawn. Data also included the specific SSRI and the starting date for the SSRI. The study showed no relationship between age, sex, SSRI prescribed and hyponatremia. However, patients that were prescribed an SSRI for less than a year were more at risk for hyponatremia. Therefore, in order to minimize the risk of hyponatremia, additional monitoring may need to be added at SSRI initiation, three months, six months, and one year, especially in patients with other medications that may lower sodium levels.
Conflict of Interest
We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.
Type: Student Projec
Description of the methods for describing and assessing the appropriateness of antibiotic prescribing and adherence to published treatment guidelines in an academic medical clinic
Get PDFOveruse and inappropriate use of antibiotics have been associated with increased rates of antimicrobial resistance and increased healthcare expenditures. Tracking inpatient antimicrobial use has helped quantify the value of stewardship programs aimed at improving the rational use of antibiotics among hospitalized patients. Unfortunately, similar methods for tracking and assessing antibiotic use in the outpatient setting have not been well described. We developed a novel method to capture trends and assess appropriateness of antibiotic usage. This strategy is based on identification of antimicrobial prescriptions in an electronic medical record system, linking prescribing to patient data, and capturing information regarding dosing and indications for use. Using information on dose, frequency, and duration of the antibiotic prescribed, a parameter to quantify antibiotic exposure (Prescribed Therapeutic Regimen, PTR) is calculated. This parameter is compared to a database of information on agents recommended in published guidelines (Recommended Therapeutic Regimen, RTR). By linking an ICD-9 code and the prescribed antibiotic we determine the appropriateness of the PTR by comparing it to the RTR for a given indication. Data are used to establish a baseline pattern of antibiotic use in the clinic to gauge the impact of future stewardship activities. Additionally, individual clinics and prescribers are given a snapshot of their antibiotic use compared to other clinics and prescribers. This is a novel means of describing antibiotic use in the outpatient setting that could serve as a standardized model for various adult and pediatric outpatient practices.
Type: Original Researc