UHSP Collections (University of Health Sciences and Pharmacy)
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Evaluation of a Novel Pharmacist-Delivered Adherence Improvement Service via Telehealth
No full textNearly half of all patients prescribed a chronic medication do not adhere to their regimen. Conversion from a 30- to 90-day medication refill is associated with improved adherence. The objective of the study was to assess the change in proportion of days covered (PDC) in those who converted to a 90-day fill and those who did not after a telehealth pharmacist-delivered, medication adherence intervention. This retrospective review involved data collected between May and December 2018. Patients with ≤85% baseline PDC rates were targeted. One group included patients who converted to a 90-day fill after the pharmacist intervention. The comparator group did not convert to a 90-day fill. Differences in median end-of-year (EOY) PDC rates for each medication class were compared between groups. An alpha level of 0.05 was set a priori. Overall, 237 patients converted to a 90-day fill and 501 did not. There was no significant difference in age, sex, and total number of drugs per patient. A Mann-Whitney U test revealed statistically significant improvements in median EOY PDC in the group that converted to a 90-day fill (+9% vs. -3%, \u3c 0.001). Pharmacist-delivered telehealth interventions were associated with improved PDC rates in those who converted to a 90-day fill
Culture - Sputum
No full textA sputum culture is an often noninvasive and most useful test in the assessment of lower respiratory tract infections. Sputum samples can be useful in other disease states, such as certain cancers; however, sampling is predominately useful for infectious diseases. Obtained sputum can be tested and evaluated via both Gram stain and microbiologic culture/sensitivity testing. These two procedures are most frequently performed simultaneously and interpreted together in the evaluation of a sputum sample. Antibiotic selection should be guideline-based and directed by results of the sputum sample
Nationally Representative Health Care Expenditures of Community-Based Older Adults with Pain in the United States Prescribed Opioids vs Those Not Prescribed Opioids
No full textObjective: To compare health care expenditures between older US adults (≥50 years) with pain who were prescribed opioid medications and those who were not. Design: Cross-sectional. Setting: Community-based adults in the 2015 Medical Expenditure Panel Survey (MEPS). Subjects: Nationally representative sample of US adults alive for the calendar year, aged 50 years or older, who reported having pain in the past four weeks. Methods: Older US adults (≥50 years) with pain in the 2015 MEPS data were identified. The key independent variable was opioid prescription status (prescribed opioid vs not prescribed opioid). Hierarchical linear regression models assessed health care expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total) in US dollars for opioid prescription status from a community-dwelling US population perspective, adjusting for covariates. Results: The 2015 study cohort provided a national estimate of 50,898,592 noninstitutionalized US adults aged ≥50 years with pain in the past four weeks (prescribed opioid N = 16,757,516 [32.9%], not prescribed opioid N = 34,141,076 [67.1%]). After adjusting for covariates, individuals prescribed an opioid had 61% greater outpatient (β = 0.477, P \u3c 0.0001), 69% greater office-based (β = 0.524, P \u3c 0.0001), 14% greater emergency room (β = 0.131, P = 0.0045), 63% greater prescription medication (β = 0.486, P \u3c 0.0001), 29% greater other (β = 0.251, P = 0.0002), and 105% greater total (β = 0.718, P \u3c 0.0001) health care expenditures. There was no difference in opioid prescription status for inpatient expenditures (P \u3e 0.05). Conclusions: This study raises awareness of the economic impact associated with opioid use among US older adults with pain. Future research should investigate these variables in greater depth, over longer time periods, and in additional populations
2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
No full textChronic disease and socioeconomic factors among uninsured patients: A retrospective study
No full textObjectives: Uninsured patients represent an understudied population. The current study aimed to estimate the burden of 10 common chronic conditions and to investigate the associated factors among patients who use free clinics for their health care needs. Methods: Patient charts from four free clinics were reviewed from January to December of 2015. Proportion of prevalence, adjusted odds ratios (AOR), and 95% confidence intervals (CI) for associations between participant characteristics and chronic conditions are reported. Results: Prevalence of hypertension and hyperlipidemia significantly differed by clinic, age, gender, race, and marital status. Compared to age 15–44 years, older patients (45–64 years, and ≥65) were 5–10 times more likely to suffer from hypertension. Compared to women, men; compared to White, African-Americans; and compared to single, married patients had higher prevalences of hypertension. Older patients were 5–8 times more likely to suffer from hyperlipidemia. Asians, and married patients were also more likely to experience hyperlipidemia. Prevalence of diabetes, depression and arthritis significantly differed by age and race. Prevalence of coronary artery disease and chronic obstructive pulmonary disease increased 6–13 folds among older patients. Discussion: Patients of free clinics suffer from high burden of chronic conditions. Patients who frequent free clinics are primarily older, unemployed, women, minorities, and are of low income
Financial investment of United States pharmacy schools on international activities
No full textIntroduction: The primary objective of this study was to determine the financial resources that United States (US) pharmacy schools spend and receive for international activities, as well as the future direction of expenditures and revenue. Methods: An online survey was sent in April 2019 to the chief financial or administrative officer at each accredited pharmacy school (N = 141) to ask about average annual budget for international activities and areas of expenditure (student travel, partnership development, faculty salary, staff salary, training programs) and revenue (dean\u27s office, university, student tuition and fees, alumni, grants and contracts, other) associated with their budget. Participants were asked whether they anticipated spending or receiving more, the same, or less on the aforementioned expenditure and revenue areas. Results: Sixty-three programs (45%) responded, with 61 (43%) complete responses used for data analysis. Thirty-eight schools (62%) had an annual budget for international activities with an average of 18,750, and a range from 615,000. Public schools averaged 43,225 for private schools. The largest expenditure source was split evenly between student travel and faculty salaries while the largest revenue source was student tuition and fees. The most common response for future trends was to spend or receive the same amount of support. Conclusions: There is wide variance regarding the amount each US pharmacy school spends on international activities, with most programs anticipating spending or receiving the same amount in the future
Global epidemiology of hip fractures: A study protocol using a common analytical platform among multiple countries
No full textIntroduction Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic reviews of studies that use different methods and study periods do not permit direct comparison across geographical regions. Thus, the objective of this study is to investigate global secular trends in hip fracture incidence, mortality and use of postfracture pharmacological treatment across Asia, Oceania, North and South America, and Western and Northern Europe using a unified methodology applied to health records. Methods and analysis This retrospective cohort study will use a common protocol and an analytical common data model approach to examine incidence of hip fracture across population-based databases in different geographical regions and healthcare settings. The study period will be from 2005 to 2018 subject to data availability in study sites. Patients aged 50 years and older and hospitalised due to hip fracture during the study period will be included. The primary outcome will be expressed as the annual incidence of hip fracture. Secondary outcomes will be the pharmacological treatment rate and mortality within 12 months following initial hip fracture by year. For the primary outcome, crude and standardised incidence of hip fracture will be reported. Linear regression will be used to test for time trends in the annual incidence. For secondary outcomes, the crude mortality and standardised mortality incidence will be reported. Ethics and dissemination Each participating site will follow the relevant local ethics and regulatory frameworks for study approval. The results of the study will be submitted for peer-reviewed scientific publications and presented at scientific conferences
Factors predicting high-dose and combined antipsychotic prescribing in New Zealand: High-dose antipsychotic prescribing
No full textObjective: Guidelines recommend using antipsychotic monotherapy at the lowest effective dose, however high-dose and antipsychotic polypharmacy prescribing (APP) remain commonplace. The aim of this study was to determine the prevalence and patterns of high-dose antipsychotic prescribing and APP among mental health service users in New Zealand (NZ). Methods: A retrospective audit of service users discharged from inpatient (n=657), or registered with community (n=1560), mental health services at Auckland District Health Board was undertaken. Case notes were reviewed and data on demographics, antipsychotic routes and doses were collected. Outcomes measures included: frequency of total high-dose prescribing, high-dose monotherapy, APP, high-dose APP, and factors associated with these prescribing practices. Logistic regression models were used to examine the relationships between explanatory and outcome variables. Results: Of the service users prescribed an antipsychotic (n = 2217), 14% were prescribed a high-dose antipsychotic. The frequency of high-dose monotherapy, APP, and high-dose APP was 3%, 26% and 11%, respectively. Being male, Māori, on compulsory treatment, having a schizophrenia diagnosis, or being prescribed polypharmacy were associated with high-dose antipsychotics. Olanzapine was most frequently prescribed in both high dosing (55%) and APP (40%). Conclusions: There is a high prevalence of high-dose prescribing and APP in this NZ setting
Endocrine pharmacotherapy education in United States colleges and schools of pharmacy
No full textBackground: As Doctor of Pharmacy (Pharm.D.) curricula are revised, it is important to identify what to retain and prioritize; previous studies have not evaluated the endocrine content within curricula at United States (U.S.) schools and colleges of pharmacy. Objective: To determine the breadth of endocrine instruction and assessment within preadvanced pharmacy practice experience (pre-APPE) coursework in the clinical sciences across U.S. Pharm.D. programs. Methods: A cross-sectional survey-based study of U.S. schools and colleges of pharmacy was completed evaluating the 2018 to 19 academic year. Data were summarized using descriptive statistics. Categorical variables were assessed using Chi-square or Fisher\u27s exact tests and ordinal variables were evaluated using Mann-Whitney U and Kruskal-Wallis tests, with a priori significance set at.05. The study was approved by the Presbyterian College Institutional Review Board with exempt status. Results: Fifty-eight of 142 (40.8%) programs participated. Contact hours for required endocrine content varied, with 57% responding with more than 30 hours. Among 15 topics, only types 1 and 2 diabetes and thyroid disorders were required at all programs. For two-thirds of the topics, the perception of topic importance differed between programs that cover and those that do not cover the topic (P \u3c.05). The most common assessment strategies included case studies (100%), multiple choice questions (97%), SOAP note writing, and skills demonstrations (72% each). The most common diabetes-related Entrustable Professional Activities (EPAs) were: evaluating drug therapy, following guidelines, and educating patients (98% each). The most commonly cited barrier to including more endocrine topics was lack of curricular time (88%). Conclusions: Inconsistency in endocrine content within curricula at U.S. PharmD programs includes topics covered, contact hours, and perception of topic importance. Respondents consistently noted their methods appropriately educated student pharmacists to develop diabetes-related EPAs. Development of a standardized endocrine curricula could establish minimal competencies for APPE-readiness
Wealth and urbanization shape medium and large terrestrial mammal communities
No full textUrban biodiversity provides critical ecosystem services and is a key component to environmentally and socially sustainable cities. However, biodiversity varies greatly within and among cities, leading to human communities with changing and unequal experiences with nature. The “luxury effect,” a hypothesis that predicts a positive correlation between wealth, typically measured by per capita income, and species richness may be one indication of these inequities. While the luxury effect is well studied for some taxa, it has rarely been investigated for mammals, which provide unique ecosystem services (e.g., biological pest control) and exhibit significant potential for negative human–wildlife interactions (e.g., nuisances or conflicts). We analyzed a large dataset of mammal detections across 20 North American cities to test whether the luxury effect is consistent for medium- to large-sized terrestrial mammals across diverse urban contexts. Overall, support for the luxury effect, as indicated by per capita income, was inconsistent; we found evidence of a luxury effect in approximately half of our study cities. Species richness was, however, highly and negatively correlated with urban intensity in most cities. We thus suggest that economic factors play an important role in shaping urban mammal communities for some cities and species, but that the strongest driver of urban mammal diversity is urban intensity. To better understand the complexity of urban ecosystems, ecologists and social scientists must consider the social and political factors that drive inequitable human experiences with nature in cities