INNOVATIONS in pharmacy (Iip - E-Journal)
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Evaluating Factors Related to the Abuse of Oral Corticosteroids among Community Pharmacy Customers: Using Theory of Reasoned Action
Full text linkIntroduction: Although it is discouraged, community pharmacy customers can obtain oral corticosteroids (OCSs) without prescriptions from some community pharmacies in Iraq. Medication abuse is defined as the use of medication for non-medical reasons.
Objectives: The study aimed to determine demographics, beliefs, and perceptions associated with the abuse of oral corticosteroids for non-illness reasons among community pharmacy customers.
Methods: This cross-sectional study was conducted in fall 2018 in four provinces in Iraq. Customers of 19 community pharmacies asking for OCSs for themselves without a prescription were administered a paper survey. This study used the Theory of Reasoned Action (TRA) to measure the relationship between the motivational factors and the abuse of OCSs. Logistic regression analysis was conducted to evaluate the relationships between the use of OCSs for non-illness and six TRA factors: Normative belief, behavioral belief, evaluation of the behavior, motivation to comply, subjective norms and attitude toward behavior.
Results: The study enrolled 141 participants (98 women and 43 men) taking asking for OCSs without prescription. Dexamethasone was the most commonly used OCSs (59.6%). Friends were the primary recommenders for corticosteroids abuse (28.4%). The main reasons for using OCSs were to increase appetite and gain weight (53.9 %). Approximately one-third (36.2 %) of the participants gained weight after using OCSs. The regression analysis of the TRA variables showed two factors were significantly related to the abuse of OCSs. Age had a significant inverse relationship with the abuse of OCSs and the "good appearance" belief had a significant positive association with OCS abuse.
Conclusion: Some Iraqi community pharmacy customers use non-prescribed oral corticosteroids to increase appetite and gain weight. Improve body appearance represents the dominant incentive that urges people to use OCSs without prescription. Health officials and healthcare practitioners need to promote people's awareness about the risks of misusing OCSs through education programs and advertisements in public health settings, media, and social media.
Article Type: Original Researc
Integration of the Saline Process on Holistic Patient Care to Improve Student Understanding of Interprofessional Team Roles, Values, and Ethics
Full text linkDescription of the Problem: Healthcare practitioner students currently report feeling underprepared to provide holistic and spiritual care to their patients upon transitioning into practice, and there is currently little data on the efficacy of holistic care-focused interventions on interprofessional outcomes. The goal of this research was to assess the impact of an interprofessional training session on holistic care on student perceptions of interprofessional 1) roles/responsibilities and 2) values/ethics.
The Innovation: A live, interactive interprofessional training session to address holistic patient care was implemented in fall of 2017. Students’ pre- and post-training perceptions of their confidence in study outcomes were assessed using a survey instrument.
Critical Analysis: Significant positive changes were seen in students’ perceived ability to participate in team discussions and clarify misconceptions regarding their role in healthcare following the training. Students had high confidence in interacting ethically at pre-test and sustained that confidence.
Next Steps: Live, interactive educational interventions with skills practice and group discussions can help to increase students’ awareness of team roles and responsibilities, as well as expand their understanding of the values and ethics within healthcare professions
Evaluation of Vitamin B12 Monitoring in Patients on Concomitant Metformin and Proton Pump Inhibitors
Full text linkBackground: Type 2 diabetes mellitus and gastroesophageal reflux disease are highly prevalent in the United States. First-line therapies for these disease states include metformin and proton pump inhibitors, respectively. Both of these medications have been associated with a decreased absorption of vitamin B12.
Objective: The objective of this study was to assess the prevalence of B12 monitoring and supplementation in patients receiving concomitant metformin and PPI therapy.
Methods: A retrospective data analysis was performed at a single federally qualified health center. Patients receiving concomitant metformin and PPI therapy (specifically omeprazole and pantoprazole) over the past year were included. Data collected included demographics, dosing, therapy duration, and vitamin B12 level. Data were analyzed using descriptive statistics.
Results: A total of 104 patients met the inclusion criteria for this study. Metformin 1000 mg immediate release tablets was the most common dose and formulation prescribed. Omeprazole and pantoprazole were the most commonly prescribed PPIs. The most frequent duration of therapy was 1 to 4 years. Fourteen patients had a documented B12 level and no patients were categorized as deficient. Seven patients were prescribed a B12 supplement during the study period.
Conclusion: In this single center, retrospective chart review of patients receiving concomitant metformin and PPI therapy, the average duration of therapy for both agents was 1-4 years. Only 13.5% of patients had a documented B12 level. Of those patients, none were categorized as deficient. Though routine monitoring of B12 levels may be important for patients on long-term therapy with both agents or who present with symptoms of B12 deficiency, this study does not support routine monitoring of B12 levels for patients with duration of therapy of 4 years or less.
Article Type: Original Researc
Student Pharmacists’ Assessment of a Serious Game on Opioid Medication Safety
Full text linkObjective: To explore second- and third-year student pharmacists’ perspectives on the design and use of a digital game to teach opioid medication safety. To explore the game-based learning approach to teach about appropriate drug use and pediatric education.
Innovation: The lead author developed MedSMA℞T: Adventures in PharmaCity, an educational video game focused on adolescent opioid safety. Second- and third-year students in a Midwestern School of Pharmacy enrolled in an elective course focused on appropriate use of abused drugs, played the digital game during a classroom session on adolescent opioid misuse. Using a small group discussion guide, students summarized their reflections and perspectives on gameplay.
Critical Analysis: Students retained fundamental messages of the game including opioid safety and identified that social interactions contribute to decision-making and consequences of opioid misuse. Student pharmacists found the game’s visual appearance engaging, dialogue amusing, and the settings and scenarios relatable. Feedback regarding game controls, environment, dialogue, instructions, and level summaries was provided by students to improve the game design and content. This project provides an example of a thoughtful approach to game-based learning in pharmacy classrooms with the purpose of enhancing student pharmacists’ knowledge about opioid safety education, communication, social collaboration, and critical-thinking.
Next Steps: Future projects can further investigate student pharmacists’ preferences of using game-based active learning. Additionally, retention rates of students from joint lectures and game-based learning activities can be analyzed
Dosage Adjustment of Irinotecan in Patients with UGT1A1 Polymorphisms: A Review of Current Literature
Full text linkObjective: To review available literature regarding pharmacogenomics (PGx) effects on the metabolism of irinotecan by the UGT1A1 gene and the resulting dose adjustments based on PGx genetic variant.
Summary: Irinotecan is a chemotherapy agent commonly used in treatment of various cancers such as metastatic colorectal cancer (mCRC) and others. The extent of decreased function of UGT1A1 varies based on genotype so irinotecan dose adjustments may be needed. Those with UGT1A1 homozygous *28/*28 genotype may experience 70% reduction in activity, while heterozygous genotypes with *1/*28 may only experience 30% loss. UGT1A1*6 variants may also play a role in decreased function. The incidence of *28 and *6 alleles varies among ethnic populations resulting in the need for dosage adjustments to avoid toxicities.
Conclusion: These findings add to a growing body of literature that suggest patients with UGT1A1 *28 or *6 variant alleles benefit from lower doses of irinotecan. However, due to the heterogeneity of currently available studies, more evidence that investigates various regimens in different patient populations is needed to determine the most appropriate dosing strategies. Although other factors, as well as efficacy considerations will likely influence clinical decision making, genotype may be an important factor when determining dose.
Review Articl
The Pharmacist’s Missing Role in COVID-19 Pandemic
No full textCoronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In Wuhan, China, the disease was first identified in December 2019 and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic. Several countries across the world are facing a shortage in frontline providers, while pharmacists are asked to cut working hours during this pandemic fight. Pharmacists as healthcare professionals could contribute in many aspects as responders to this pandemic worldwide if they had expanded education, training, and scope of practice.
Article Type: Commentar
RETRACTED: Pharmacist-Led Discharge Medication Counseling and its Corresponding Impact on Medication Adherence and Hospital Readmission Rates
Full text linkThis article has been retracted: please see INNOVATIONS in pharmacy retraction policy (https://pubs.lib.umn.edu/index.php/innovations/policies). The authors and editors have agreed to voluntarily retract the article due to allegations of erroneous use of an assessment tool.
Objectives: Pharmacists have been shown to reduce hospital readmission rates and improve adherence rates by providing discharge medication counseling and offering services such as a bedside delivery program.1 Hospitals are now penalized by Medicare if patients are readmitted within 30 days of discharge, so implementation of these programs have the potential to be financially significant as well.2 The primary endpoint of this study is to evaluate the impact of a pharmacist discharge medication counseling bedside delivery program on medication adherence rates within a six-week period following discharge. The secondary endpoint focuses on hospital readmission rates. The objective of this study is to increase collaboration between community pharmacies and hospitals in order to improve the quality of patient care.
Methods: This study was designed as intervention versus control, whereas the intervention patients were those who received counseling from a pharmacist or pharmacist intern and control patients were those who did not within the same time period. Collected patient data (n=81) included patients’ demographic data and all disease states, genders, and insurance coverage were encompassed by the included patients. Medication adherence was measured at follow-up intervals utilizing the proportion of days covered (PDC) equation, where a score of at least 80% is required for optimal therapeutic efficacy. Informed consent was obtained from all participants regarding a follow-up telephone call or retrieval of medication records through the pharmacy electronic medication records system and hospital electronic medical records system. Approximately 10-15-minute counseling sessions were performed at the time of discharge. Follow-up phone calls were conducted for the intervention group at four-weeks and six-weeks post-discharge to discuss medication adherence and side effects experienced.
Results: There was a total of 81 patients enrolled in this study. There were 27 patients in the intervention group and 54 patients in the control group. The pharmacist-led discharge counseling sessions made a statistically significant difference in medication adherence rates (p<0.001) as calculated using PDC, showing adherence rates of 84.4% in the intervention group and 62.8% in the control group. The pharmacist-led discharge counseling sessions made a statistically significant difference in hospital readmission rates (p=0.022), with a 24% readmission rate in the control group and a 3% readmission rate in the intervention group.
Conclusion: Pharmacist involvement in a bedside delivery program helps to improve medication adherence in patients being discharged from a hospital. A PDC of at least 80% is required for optimal therapeutic efficacy in most classes of chronic medications, and only the intervention arm reached this threshold.3 The findings also show a statistically significant reduction in hospital readmission rates for patients receiving a pharmacist-led discharge counseling session.
Article Type: Original Researc
The Visibility of Disabilities within Pharmacy Program Recruitment Material
Full text linkBackground: Targeted recruitment of students with disabilities is a novel area in pharmacy education and may help to attract qualified students in light of decreasing applicant numbers. The aim of this study was to explore the visibility of disabilities within online recruitment material for pharmacy programs and to determine the location of targeted information available to prospective students with disabilities.
Methods: The top 50 ranked programs offering a professional pharmacy degree under the Pharmacy and Pharmacology QS subject rankings were identified and included if recruitment material was published in English. Online recruitment material was reviewed for presence of persons with disabilities in photos, presence or description of persons with disabilities in videos, information specific to disabilities on the program website (e.g. technical standards), and information specific to disabilities on the university website (if not located on the program website).
Results: A total of 41 international program websites met the inclusion criteria. No programs included pictures or videos featuring persons with disabilities. A total of 18 (44%) of programs had disability information on the program website and an additional 18 (44%) of programs included information on the university website. There were 5 (12%) of programs that did not include any information about disabilities on the program or university website.
Conclusion: Recruitment material for pharmacy degree programs should be current, inclusive, and reflective of student populations eligible to be admitted. This study found a distinct underrepresentation of students with disabilities and information pertaining to disabilities within recruitment material for a sample of international pharmacy programs.
Article Type: Original Researc
Assessing Readiness of Community Pharmacists to Perform and Document Medically Billed Clinical Services
Full text linkObjectives: To assess the readiness of community pharmacists in documenting and performing medically billed clinical services. Additionally, the preferred training method of community pharmacists was evaluated.
Methods: This study surveyed practicing pharmacists in a chain community pharmacy in Washington State via a voluntary, anonymous online survey through Qualtrics. Data collected in the survey measured each pharmacist’s self-perceived ability to perform examinations and to gather and document patient subjective and objective information compliant with medical billing requirements. In addition, questions evaluated the training methods pharmacists preferred in the community setting. The data was aggregated and analyzed utilizing descriptive statistics to assess pharmacists’ self-perceived baseline understanding regarding documenting and performing medically billed clinical services as well training preferences of the pharmacists surveyed.
Results: Pharmacists in the study had a generally higher perceived ability in performing past medical history, medical decision-making and clinical documentation of a medical visit. In contrast, pharmacists in the community setting had a lower perceived ability performing physical assessment criteria in a medically billed clinical visit. This study indicated that pharmacists in the community setting preferred live small-group training on future medical billing.
Conclusion: Pharmacists have some of the skills necessary to perform and bill clinical visits; however, there is room for improvement in particular areas where pharmacists have a lack of training and experience.
Article Type: Original Researc
Exploring the Impact of Technology Use with Cosmetic Science Guest-Speakers: A Qualitative Study
Full text linkImprovements in current classroom technology such as video conferencing have allowed geographically-distant guest-speakers to participate in teaching. However, is time and effort that faculty may spend coordinating guest-speakers helpful for their students’ learning? Relevance is key to motivation and learning, and therefore, it would seem that professionals who can share industry applications and their experiences should help promote relevance. During the core application-based cosmetic science coursework in an undergraduate cosmetic science and formulation design degree at the University of Toledo, multiple industry experts come in as guest-speakers. The majority of them join remotely via a real-time video conferencing tool. The purpose of this study was to both explore the impact of guest-speakers on these students’ learning, as well as to understand how guest-speakers might also value these experiences. Twenty-two students and sixteen guest-speakers participated. Using a qualitative approach, authors used an inductive thematic analysis of transcripts from focus-groups of students and interviews of guest-speakers. Twenty-one codes were identified, and five themes were constructed for both the student and guest-speaker groups. Themes from both groups were integrated and distilled into an essence related to teaching and learning. Our results indicated that students greatly appreciated the relevance from guest-speakers to augment their introductory/foundational instruction from faculty. From guest-speakers’ perspectives, teaching students was formative towards developing informed future coworkers for the cosmetic industry. Technology enabled much of this. Overall, we believe that professional, experienced guest-speakers can make an impact on students. We hope that other higher education institutions might consider technology to foster use of guest-speakers within their programs.
Article Type: Original Researc