INNOVATIONS in pharmacy (Iip - E-Journal)
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Identifying medication-related needs of HIV patients: foundation for community pharmacist-based services
Get PDFBackground: Patients living with HIV/AIDS have complex medication regimens. Pharmacists within community pharmacy settings can have a role managing patients living with HIV/AIDS. Patients' perspectives surrounding implementation about community pharmacist-based services is needed as limited information is available.
Objective: To identify medication-related needs of HIV-infected patients who receive prescriptions from a community pharmacy. To determine patient perspectives and knowledge of community pharmacist-based services.
Methods: A qualitative research study involving in-depth, semi-structured interviews with patients was conducted.
Inclusion criteria included: HIV positive men and women at least 18 years of age who receive care at a HIV clinic, currently take medication(s) and use a community pharmacy for all prescription fills. Patients were recruited from one urban and one rural health center. Patients answered questions about their perceptions and knowledge about the role and value of pharmacy services and completed a demographic survey. The recordings of the interviews were transcribed verbatim and were analyzed using principles of Grounded Theory.
Results: Twenty-nine interviews were conducted: 15 participants from the urban site and 14 from the rural site. Five main themes emerged including: patients experience ongoing and varying medication-related needs; patients desire a pharmacist who is caring, knowledgeable and integrated with health care providers; patients expect ready access to drug therapy; patients value an individualized patient encounter, and patients need to be informed that a pharmacist-service exists.
Conclusion: Patients with HIV value individualized and personal encounters with pharmacists at time intervals that are convenient for the patient. Patients felt that a one-on-one encounter with a pharmacist would be most valuable when initiating or modifying medication therapy. These patient perspectives can be useful for pharmacists and pharmacies interested in providing advanced care to patients with HIV.
Type: Original Researc
Team-based learning (TBL): An Argument for Faculty's Evaluation
Get PDFTeam-based learning (TBL) is increasingly used for presenting educational information to students in colleges of pharmacy. Several studies have shown a positive impact on students both in terms of academic performance and comprehension. Current literature does not provide the full perspective of faculty, who are incorporating this methodology into the classroom. Cross-sectional surveys and commentary within manuscripts describe mixed findings regarding the faculty's perception of TBL. The aims of this paper are: 1) to describe why faculty evaluation of TBL is important, 2) to outline variables for consideration in faculty evaluations of TBL, and 3) to describe uses for the data from faculty evaluation of TBL.
Type: Idea Pape
A pilot project to assess community pharmacists' knowledge and caring behaviors for recurrent headache sufferers after a migraine-focused educational intervention
Get PDFObjectives: (1) Compare pharmacists' self-assessed knowledge of migraine before and after an educational intervention; (2) Compare pharmacists' self-reported care behaviors following an educational intervention with a control group of pharmacists; (3) Identify interactions between the educational intervention results and individual independent variables.
Design: Quasi-experimental, parallel design.
Setting: Twenty community pharmacies in northeastern Oklahoma from March to May 2010.
Participants: 49 pharmacists at one of twenty community pharmacies, with active and in-good-standing Oklahoma pharmacy licenses.
Intervention: Two-hour educational session on migraine identification and current treatment.
Main outcome measures: Compare pharmacists' self-assessed knowledge of migraine before and after an educational intervention and compare self-reported care behaviors of these same pharmacists with a control group of pharmacists.
Results: Pharmacists' self-assessed knowledge mean scores were significantly higher post-intervention compared to pre-intervention (p<0.0001). Self-assessed knowledge was higher in the intervention group post-questionnaire scores compared to the control group of pharmacists (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). No significant interactions were found between the educational intervention and demographic variables collected.
Conclusion: Attending an educational program on migraine improved pharmacists' knowledge and confidence when providing care to migraineurs.
Type: Original Researc
Validity of Electronic Prescription Claims Records: A Comparison of Commercial Insurance Claims with Pharmacy Provider Derived Records
Get PDFObjectives: To determine if and to what extent records obtained from PBM pharmacy claims differ from source documents obtained directly from pharmacy providers. This study also sought to explore possible associations between patient, pharmacy benefits, and pharmacy provider characteristics and the likelihood a patient would have missing prescription claims.
Methods: This study used a cross-sectional design which included a sample of 1,484 patients residing in a single state with a common pharmacy benefit. Profiles describing all prescriptions filled in a pharmacy between January 1, 2002 through June 30, 2002 of these patients were requested directly from their pharmacy providers. Logistic regression was used to explore the factors associated with a person receiving a prescription that did not appear on the PBM claims.
Results: Of the 1,484 eligible recipients sampled, profiles were obtained for 323 (22%) persons and there were analyzable profiles for 315 (21%) persons. There were a total of 2,977 prescriptions filled for the 315 subjects. Of those 2,977 prescriptions, 207 (7.0%) were missing from the claims files indicating that 93% were captured. Only prescription volume consistently influenced the likelihood a patient would have a missing prescription from the PBM claims (OR =1.08; 95%CI:1.05-1.12).
Conclusion: Claims obtained from pharmacy benefit companies capture approximately 93% of prescription records when verified with records obtained from pharmacy providers. The rate of missing records from PBM claims does not appear to be meaningfully influenced by most finance based pharmacy benefit design features. However, certain classes of drugs such as iron products, digoxins, diuretics, sulfonylureas, and antigout may have incomplete claims records compared to other classes of drugs. Higher prescription utilizers are more likely to have prescription records filled that are not captured by PBMs. These conclusions should be interpreted in light of the modest usable response rate from pharmacy providers of 22% and the unknown generalizability of these patients utilizing one particular PBM from 2002 in the state of Georgia.
Type: Original Researc
Medication non-adherence in the homeless population in an Intermountain West city
Get PDFBackground: Homelessness happens when people or household are unable to acquire and/or maintain housing they can afford. Approximately 17% of homeless individuals are also chronically ill. Studies have often not objectively measured medication non- adherence among the homeless population, probably due to lack of consistent pharmacy records. This study proposed to objectively estimate medication non-adherence to chronic medications among the homeless population in Salt Lake City, Utah.
Methods: A retrospective study design was used based on the pharmacy records from the Fourth Street Pharmacy based on four classes of chronic medications - asthma, diabetes, statins, and psychiatric medications. Data was collected between November 1, 2010 and February 28, 2011 on the variables: date of original prescription, number of refills on the original prescription, date of 1st, 2nd, 3rd, and 4th fills, age, gender, and race. Primary non-adherence and medication refill non-adherence based on Continuous Measure of Medication Gaps were calculated.
Results: The medication refill non-adherence rate was 38.8% with asthma medications, 38.5% with diabetic medications, 27.2% with statins, and 47.1% with psychiatric medications. The primary non-adherence rate varied from zero percent to 20%.
Conclusion: The study concluded that this population has comparable non-adherence rates with asthma, diabetes, cholesterol lowering, and certain psychiatric medications than the general population.
Type: Original Researc
Evaluating the Impact of Drug Dispensing Systems on the Safety and Efficiency in a Singapore Outpatient Pharmacy
Get PDFPurpose: Automation of pharmacy workflow can reduce medication errors as well as improve efficiency of the medication picking, packing and labeling process. Since September 2012, two drug dispensing systems (DDS) began operations in the Singapore General Hospital Specialist Outpatient Clinic Pharmacy. This study sought to evaluate the impact of the DDS on safety and efficiency in the pharmacy.
Methods: The primary outcome was the rate of prevented dispensing incidents contributed by DDS or manual picking of medications defined as the number of prevented dispensing incidents per 1000 medications picked. The secondary outcome was the productivity of each full time equivalent (FTE) when assigned to either the DDS or manual picking stations. Data pertaining to the primary and secondary outcomes between January and December 2013 were collected and analyzed. The rate of prevented dispensing incidents was expressed in median (interquartile range) and compared using Mann-Whitney U test. Other continuous variables were expressed in mean ± standard deviation and compared using independent samples t-test.
Results: An average of 59494 medications was picked every month in the pharmacy. DDS accounted for 21.1 percent while manual picking accounted for 78.9 percent of all the medications picked. The median rate of prevented dispensing incidents per month committed by manual picking (2.73) was significantly higher than the DDS (0.00). DDS had greater productivity with each FTE in the DDS having an average of 6175 picks per month which was significantly higher than each FTE in the manual picking stations which had an average of 4867 picks per month.
Conclusion: Installation of DDS in an outpatient pharmacy improved safety of the pharmacy workflow by automating the medication picking, packing and labeling process and minimizing human errors. Efficiency of the medication picking, packing and labeling process was also improved by the DDS as there were continuous efforts to boost their productivity as well as being more reliable and better able to handle fluctuations in patient load.
Type: Original Researc
Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8)
No full textErratum
Redacted by authors in order to address a question regarding the use of a measure.
Type: Original Researc
International Variations In Essential Medication Lists
Get PDFEvery nation in the world has established a National Medication Formulary to account for all the medications present in the country. Many countries follow the Essential Medication List provided by the World Health organization (WHO) when making their own National Medication Formulary. Our study looked at variations in the National Formularies when compared to the Essential Medication Lists. Different relationships such as missing and extra medications lists were formulated and the statistics analyzed. It was noted that on average most of the countries studied were lacking 47% of medications, and had 30% additional medications on their national formulary. Further studies need to be conducted as Essential Medications may be lacking, or harmful medications may be present in a country's formulary leading to severe health problems.
Type: Commentar
Fluconazole-Associated Birth Defects: A Comprehensive Review
Get PDFBackground: The August 2013 publication of a large historical cohort study in the New England Journal of Medicine has reignited interest in the potential teratogenic effects of fluconazole when used in pregnant females. Fluconazole is an effective and commonly-utilized antifungal medication. Thus, maternal and fetal exposure to fluconazole is expected in the general population, and pharmacists are expected to counsel patients regarding any risks to their prescribed treatment.
Methods: A literature review of all published literature indexed to PubMed (January 1966 to October 2013) and International Pharmaceutical Abstracts (January 1975 to October 2013) including fluconazole and teratogenic effects and published in the English language was conducted.
Results: Fourteen publications were included for analysis including case reports (n=7), cross-sectional research (n=2), and historical cohort studies (n=5).
Conclusion: There appears to be little to no fetal risk resulting from a single dose or short duration antifungal therapy with fluconazole. However, prolonged high-dose fluconazole therapy has increased potential to confer teratogenic effects. In those cases, the risks of such therapy should be weighed against potential benefits.
Type: Student Projec
Perceived Impact of a Longitudinal Leadership Program for All Pharmacy Students
Get PDFObjective: To describe a longitudinal leadership program involving all students and report the perceived impact.
Design: The program included a first year Leadership Interview, a third year Report of Leadership, and a fourth year Professional Business Meeting Attendance. Activities involved guided reflection.
Assessment: Students (n=138) indicated the activities helped them recognize the importance of leadership and their leadership potential (e.g., 72.5% and 62.3% of students due to meeting attendance, respectively). Students participated in leadership activities that they would not have pursued otherwise, either in response to the activity (27.7% due to interview) or as a requirement of the activity (51.1% for leadership report). Students reported developing specific leadership skills through the activities. Most students planned to be involved in a district/regional (72.5%), state (84.1%), and national (51.4%) meeting in the five years following graduation.
Conclusion: Students reported a positive impact on leadership perceptions and participation. The report is a preliminary step in the development and assessment of a longitudinal curricular initiative involving all pharmacy students.
Type: Case Stud