Browsing by Subject "Pharmacists"

Now showing 1 - 10 of 12
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    532 The Impact of a Clinical Pharmacist on Medication Management in an Adult Burn Clinic
    (Oxford University Press, 2023-05-15) Boyd, Allison; Walroth, Todd; Meadows, Katherine; Spera, Leigh; Hartman, Brett; Medicine, School of Medicine
    Introduction: Pharmacists in our burn center have historically assisted with discharges and transitions of care for patients sent home or to a facility. Despite these efforts, pharmacists were not formally involved in managing burn clinic patients. Collaborative Drug Therapy Management (CDTM) protocols allow pharmacists working within a defined context to independently assume responsibility for direct patient care activities. The goal of implementing this model in our clinic was to improve access to care and streamline management of pharmacologic issues. The objective of our study was to assess the impact of a clinical pharmacist on medication management in an adult burn clinic via a CDTM protocol. Methods: The CDTM protocol allows pharmacists to independently manage the following disease states via in-person or telephone visits: pain, agitation, delirium, insomnia, venous thromboembolism, skin/soft tissue infections, and hypermetabolic complications. All treatment decisions, interventions, and education are documented in the electronic record. “Incident-to” billing is completed at Level 99211. All pharmacist visits between 1/1/22-9/21/22 were included for review in the study. Demographics were reported for unique patients, and interventions were included from each visit for patients with multiple pharmacist visits. Results: A total of 19 patients were seen at 39 visits with a clinical pharmacist during the study. Patients were mostly males (84%) with a mean (SD) age of 45 (18) years. Majority of patients were in-state (95%), with 11 (58%) being from an outside county. Patients were seen for a median (IQR) of 2 (1,2) visits each. Additional interventions were made in 12 patients (63%) at 19 visits (49%), including medication reconciliation [16 (41%)], medications ordered [14 (36%)], labs ordered [2 (5%)], referrals placed [1 (3%)], and allergies addressed [1 (3%)]. At applicable visits, patients had a median (IQR) of 2 (1,2) interventions made or 2 (1, 3) medications ordered. Conclusions: Historically, pharmacists were only involved with clinic patients when issues arose, serving in an “as-needed” capacity. Pharmacists are now able to proactively help with medication reconciliation, medication prescribing, ordering labs, and placing referrals. Implementing a CDTM protocol has allowed our pharmacists to become more formally involved in post-discharge follow-up and managing ambulatory burn patients. Applicability of Research to Practice: To our knowledge, ours is the first burn center to implement a Clinical Pharmacist CDTM Protocol, which may serve as a framework for others. Future directions include continuing to track data for adherence, medication access, billing/reimbursement, and clinical outcomes.
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    Bridging the Gap in Tobacco Cessation Services: Utilizing Community Pharmacists to Facilitate Transitions of Care in the USA
    (Springer, 2022) Newlon, Jenny; Ellis Hilts, Katy; Champion, Victoria; Suchanek Hudmon, Karen; School of Nursing
    Interprofessional strategies for promoting tobacco cessation lead to enhanced quit rates among patients; however, current approaches might not effectively support patients with their quit attempts after they are discharged from the hospital. This paper explores opportunities for interprofessional collaboration between health system-based providers and community pharmacists, as one proposed approach to bridging tobacco cessation services during transitions of care. Suggested strategies include (1) increasing other healthcare professionals' awareness of legislative advances that permit pharmacists to prescribe cessation medications in some states, and (2) encouraging bi-directional communication between health system-based and community-based providers, especially via integrated electronic health records. Community pharmacists can offer a convenient solution to obtain the post-discharge medication and counseling support that patients need to increase their chances of quitting for good. Additional steps are discussed to improve broadscale capacity of this service being provided in community pharmacies.
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    CYP3A4 and CYP3A5 Genotyping Recommendations: A Joint Consensus Recommendation of the Association for Molecular Pathology, Clinical Pharmacogenetics Implementation Consortium, College of American Pathologists, Dutch Pharmacogenetics Working Group of the Royal Dutch Pharmacists Association, European Society for Pharmacogenomics and Personalized Therapy, and Pharmacogenomics Knowledgebase
    (Elsevier, 2023) Pratt, Victoria M.; Cavallari, Larisa H.; Fulmer, Makenzie L.; Gaedigk, Andrea; Hachad, Houda; Ji, Yuan; Kalman, Lisa V.; Ly, Reynold C.; Moyer, Ann M.; Scott, Stuart A.; van Schaik, Ron H. N.; Whirl-Carrillo, Michelle; Weck, Karen E.; Medical and Molecular Genetics, School of Medicine
    The goals of the Association for Molecular Pathology Clinical Practice Committee's Pharmacogenomics (PGx) Working Group are to define the key attributes of pharmacogenetic alleles recommended for clinical testing and a minimum set of variants that should be included in clinical PGx genotyping assays. This document series provides recommendations for a minimum panel of variant alleles (tier 1) and an extended panel of variant alleles (tier 2) that will aid clinical laboratories when designing assays for PGx testing. The Association for Molecular Pathology PGx Working Group considered functional impact of the variant alleles, allele frequencies in multiethnic populations, the availability of reference materials, and other technical considerations for PGx testing when developing these recommendations. The goal of this Working Group is to promote standardization of PGx gene/allele testing across clinical laboratories. This document will focus on clinical CYP3A4 and CYP3A5 PGx testing that may be applied to all CYP3A4- and CYP3A5-related medications. These recommendations are not to be interpreted as prescriptive but to provide a reference guide.
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    Evaluation of Student Pharmacists’ Attitudes and Perceptions of Hormonal Contraception Prescribing in Indiana
    (MDPI, 2021-11-12) Papineau, J. Henry; Newlon, Jenny L.; Ades, Ryan S.; Vernon, Veronica; Wilkinson, Tracey A.; Thoma, Lynn M.; Meredith, Ashley H.; Pediatrics, School of Medicine
    Community pharmacists' scope of practice is expanding to include hormonal contraceptive prescribing. Prior to introducing statewide legislation, it is important to assess the perceptions of future pharmacists. A cross-sectional survey was distributed to 651 third- and fourth-year professional students enrolled at three colleges of pharmacy in Indiana. Data were collected between September and October 2019 to assess students' attitudes about prescribing hormonal contraceptives, readiness to prescribe, perceived barriers, and desire for additional training. In total, 20.9% (n = 136) students responded. Most (89%, n = 121) believe that pharmacist-prescribed hormonal contraceptives would be beneficial to women in Indiana, and 91% (n = 124) reported interest in providing this service. Liability, personal beliefs, and religious beliefs were the most commonly cited perceived barriers. Most students felt they received adequate teaching on hormonal contraceptive methods (90%, n = 122) and hormonal contraceptive counseling (79%, n = 107); only 5% (n = 7) felt ready to provide the service at the time of survey completion. Student pharmacists in their final two years of pharmacy school are interested in prescribing hormonal contraceptives and believe that this service would be beneficial. This expansion of pharmacy practice would likely be supported by future pharmacists who feel the service could provide benefit to women seeking hormonal contraceptives in Indiana.
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    Exploratory analysis of medication adherence and social determinants of health among older adults with diabetes
    (Elsevier, 2023-11-15) Blakely, M. L.; Sherbeny, F.; Hastings, T. J.; Boyd, L.; Adeoye-Olatunde, O. A.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Background: Diabetes is the fifth leading cause of death in the United States (US), affecting approximately 27%, or 15.9 million adults 65 years of age and older. Diabetes is the most expensive chronic condition in the US and accounts for the second largest avoidable healthcare cost. Adherence to long-term medication treatment plans is crucial among patients with diabetes because it decreases risk of developing comorbid conditions and improves quality of life. Greater exposure to adverse social determinants of health (SDOH) over an individual's lifespan can result in worse health outcomes. Hence, it is important to obtain a better understanding of how social determinants of health (SDOH) influence patients' behaviors and affect medication adherence among older adults with diabetes. Objectives: Identify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with diabetes. Secondary objectives were to characterize SDOH, estimate medication adherence, and explain implications for health disparity populations among older adults in the US who have been diagnosed with diabetes. Methods: This study used a cross-sectional secondary data analysis to examine the National Health and Nutrition Examination Survey database, identifying associations between SDOH and medication adherence among older adults with diabetes in the US. Results: A total of 1807 respondents' data were included in the analyses. Nearly three-quarters (73.9%) of patients were considered adherent to their oral diabetes medications. Multivariable analysis revealed significant differences in medication adherence based on disability status (p = 0.016), household balanced meals (p = 0.033), and interview language (p = 0.008). Conclusions: Results revealed those with a disability, those who could not afford a balanced meal, and/or those who spoke English were associated with a higher likelihood of being nonadherent to their diabetes medications in comparison to individuals not in these groups. These findings can assist in developing SDOH-centered medication adherence strategies for pharmacists to implement with older patients with diabetes.
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    Implementation of a Pharmacist-led Hormonal Contraceptive Prescribing Service in a Campus Community Pharmacy in Indiana, United States
    (Elsevier, 2022) Ahmad, Zoona M.; Noel, Nicole L.; Rudd, Trexie M.; Nadelson, Craig S.; Ott, Mary A.; Wilkinson, Tracey A.; Meredith, Ashley H.; Pediatrics, School of Medicine
    Objective(s): College-age people have the highest numbers of unintended pregnancies and pharmacies within college campuses are in a unique position to meet student needs. Our objective was to implement a pharmacist contraceptive prescribing service in a campus pharmacy and examine the service utilization. Study design: The Purdue University Pharmacy (Indiana, United States) implemented a pharmacist hormonal contraception prescribing service via a collaborative drug therapy management agreement with the campus student health center. The collaborative drug therapy management agreement enables pharmacists to independently prescribe pills, patches, rings, injections, and emergency contraception to students meeting eligibility criteria. After completing a patient health screening and blood pressure check, the pharmacist discusses the eligible method(s) and prescribes up to a 12-month supply. A referral to another provider for long-acting reversible contraception or further evaluation may also be provided. We collected basic information about each encounter (e.g., age, blood pressure, method of contraception prescribed, and time). Results: During the 2020-2021 academic year, 125 prescribing consultations took place with an average appointment length of 20 minutes (range, 12-65 minutes). The median patient age was 21 years (range, 18-30 years). Eligible patients (n = 123, 98%) received a prescription and 119 (95%) prescriptions were written: combined oral pill (n = 91, 77%), injection (n = 12, 10%), patch (n = 6, 5%), vaginal ring (n = 5, 4%), and progestin only pill (n = 5, 4%). Conclusion(s): The pharmacist contraception prescribing service developed by the Purdue University Pharmacy and Student Health Center is a unique approach to meeting the needs of students. Few external resources are required for implementation, and most patients were medically eligible to receive hormonal contraception. Implications: Collaboration between on-campus student health centers and pharmacies can be explored as 1 approach to increase access to hormonal contraception for students.
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    Pharmacist Outlooks on Prescribing Hormonal Contraception Following Statewide Scope of Practice Expansion
    (MDPI, 2019-07-18) Rafie, Sally; Richards, Emily; Rafie, Samantha; Landau, Sharon Cohen; Wilkinson, Tracey A.; Pediatrics, School of Medicine
    In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a statewide protocol is the most common. This study was designed to explore the outlooks of pharmacists regarding prescribing contraception in the period following the first state legislation and prior to statewide protocol development and availability. A qualitative study of community pharmacists in California using structured phone interviews explored their opinions regarding access to contraception in pharmacies and outlooks regarding prescribing. Data were analyzed using an inductive approach to identify themes. Among the thirty participants, the majority worked in a chain pharmacy. Themes were identified in five overarching domains: Pharmacist barriers, system barriers, patient issues, safety concerns, and pharmacist role. Most were unfamiliar with the new law, yet were interested in expanding access for patient benefit despite foreseeing challenges with implementing the service in community pharmacies. Barriers will need to be addressed and requisite training disseminated widely to facilitate successful implementation and thus improve access on a broad scale. Further research following protocol implementation is needed to understand service implementation, as well as patient utilization and satisfaction.
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    Pharmacy program to improve care for veterans with transient ischaemic attack: a pilot implementation evaluation
    (BMJ, 2022-09-08) Rattray, Nicholas; Damush, Teresa M.; Myers, Laura; Perkins, Anthony J.; Homoya, Barbara; Knefelkamp, Christopher; Fleming, Breanne; Kingsolver, Andrea; Boldt, Amy; Ferguson, Jared; Zillich, Alan; Bravata, Dawn M.; Biostatistics, School of Public Health
    Background: Early evaluation and effective communication to manage transient ischaemic attacks (TIA) may lead to a reduction of up to 70% in recurrent events for patients with TIA/minor stroke, along with reduced costs and lengths of hospital stay. Methods: We conducted a single site pilot evaluation of a clinical pharmacy programme to improve medication management among TIA patients. The programme included a structured protocol, online identification tool, and a templated discharge checklist. Primary effectiveness measures were change in systolic blood pressure (SBP) 90 days post discharge and prescription of high/moderate potency statins. Contextual aspects and clinical perspectives on the implementation process were evaluated through prospective semistructured interviews with key informants. Results: The analysis included 75 patients in the preimplementation group and 61 in the postimplementation group. The mean SBP at 90 days post discharge was significantly lower in the post implementation period (pre implementation, 133.3 mm Hg (SD 17.8) vs post implementation, 126.8 mm Hg (16.6); p=0.045). The change in SBP from discharge to 90 days post discharge was greater in the postimplementation period (15.8 mm Hg (20.5) vs 24.8 mm Hg (23.2); p=0.029). The prescription of high/moderate potency statins were similar across groups (pre implementation, 66.7% vs post implementation, 77.4%; p=0.229). Front-line clinicians involved in the pilot study reported positively on the acceptability, appropriateness and feasibility of implementing the protocol without additional cost and within current scope of practice. Conclusions: Implementation of a clinical protocol outlining medication management and provider communication to ensure rapid postdischarge treatment of TIA patients was associated with SBP improvements. The pilot evaluation demonstrates how clinical pharmacists may play a role in treating low frequency, high stakes cerebrovascular events where early treatment and follow-up are critical.