Adriane N. Irwin

Challenges to publishing pharmacy resident research projects from the perspectives of residency program directors and residents

Objective To identify barriers to completing and publishing pharmacy residency research projects from the perspective of program directors and former residents. Methods This was a cross-sectional survey of pharmacy residency program directors and former post-graduate year one and two residents. Directors of pharmacy residency programs whose residents present their projects at the Western States Conference (n=216) were invited to complete an online survey and asked to forward the survey to former residents of their program in 2009, 2010, or 2011. The survey focused on four broad areas: 1) demographic characteristics of the residency programs, directors, and residents; 2) perceived value of the research project; 3) perceived barriers with various stages of research; and 4) self-identified barriers to successful research project completion and publication. Results A total of 32 program directors and 98 residents completed the survey. The minority of programs offered formal residency research training. Both groups reported value in the research project as part of residency training. Significantly more directors reported obtaining institutional review board approval and working through the publication process as barriers to the research project (46.7% vs. 22.6% and 73.3% vs. 43.0%, respectively p<0.05) while residents were more likely to report collecting and analyzing the data as barriers (34.4% vs. 13.3% and 39.8% vs. 20.0%, respectively, p<0.05). Both groups self-identified time constraints and limitations in study design or quality of the study as barriers. However, while program directors also indicated lack of resident motivation (65.5%), residents reported lack of mentorship or program structural issues (43.3%). Conclusions Overall, while both groups found value in the residency research projects, there were barriers identified by both groups. The results of this study may provide areas of opportunity for improving the quality and publication rates of resident research projects.

Assessment of Warfarin Dosing Requirements After Bariatric Surgery in Patients Requiring Long-Term Warfarin Therapy

To quantify the change in weekly warfarin dose after bariatric surgery in patients requiring long‐term warfarin therapy.

Use of a pharmacy technician to facilitate postfracture care provided by clinical pharmacy specialists

PURPOSE The ability of a pharmacy technician to support the patient screening and documentation-related functions of a pharmacist-driven osteoporosis management service was evaluated. METHODS A two-phase prospective study was conducted within a large integrated health system to assess a pharmacy technicians performance in supporting a multisite team of clinical pharmacy specialists providing postfracture care. In phase I of the study, a specially trained pharmacy technician provided support to pharmacists at five participating medical offices, helping to identify patients requiring pharmacist intervention and, when applicable, collecting patient-specific clinical information from the electronic health record. In phase II of the study, the amount of pharmacist time saved through the use of technician support versus usual care was evaluated. RESULTS The records of 127 patient cases were reviewed by the pharmacy technician during phase I of the study, and a pharmacist agreed with the technicians determination of the need for intervention in the majority of instances (92.9%). An additional 91 patient cases were reviewed by the technician in phase II of the research. With technician support, pharmacists spent less time reviewing cases subsequently determined as not requiring intervention (mean ± S.D., 5.0 ± 3.8 minutes per case compared with 5.2 ± 4.5 minutes under the usual care model; p = 0.78). In cases requiring intervention, technician support was associated with a reduction in the average pharmacist time spent on care plan development (13.5 ± 7.1 minutes versus 18.2 ± 16.6 minutes with usual care, p = 0.34). CONCLUSION The study results suggest that a pharmacy technician can accurately determine if a patient is a candidate for pharmacist intervention and collect clinical information to facilitate care plan development.

Impact of a clinical pharmacy research team on pharmacy resident research.

PURPOSE A successful initiative by Kaiser Permanente Colorado (KPCO) to support pharmacy resident research projects and the publication of project results in peer-reviewed journals is described. METHODS An observational study was conducted to evaluate the publication rates for resident research projects before and after the KPCO pharmacy department established a Clinical Pharmacy Research Team (CPRT) to encourage and enable resident research. All projects presented by KPCO residents at the annual Western States Conference (WSC) for Pharmacy Residents, Fellows, and Preceptors in the 10 years before the CPRT was established (1994-2004, the pre-CPRT group) and the 7 years after CPRT implementation (2005-11, the CPRT group) were included in the analysis. The proportions of presented projects in the two groups that were subsequently published in peer-reviewed journals were compared, with further analysis of project characteristics and publication outcomes. RESULTS A total of 66 resident research projects were presented at the WSC during the study period: 30 (45.5%) and 36 (54.5%) in the pre-CPRT and CPRT groups, respectively. Overall, 45 projects (68.2%) were published in peer-reviewed journals. Projects in the CPRT group were significantly more likely than those in the pre-CPRT group to result in peer-reviewed publications (publication rate, 86.1% versus 46.7%; p = 0.001). The median times from residency completion to publication in the pre-CPRT and CPRT groups were 30 and 23 months, respectively (p = 0.08). CONCLUSION An increase in the proportion of pharmacy resident research projects published in peer-reviewed journals was observed after the CPRT was established.

Labor Costs and Economic Impact of a Primary Care Clinical Pharmacy Service on Postfracture Care in Postmenopausal Women

To compare costs associated with two osteoporosis management interventions and to quantify cost avoidance due to projected hip fracture prevention.

A descriptive evaluation of warfarin use in patients with pulmonary arterial hypertension

INTRODUCTION Although warfarin is often recommended for pulmonary arterial hypertension (PAH) management to mitigate thrombotic risk and improve survival, limited information exists to guide anticoagulation therapy. The purpose of this study was to compare and contrast warfarin therapy monitoring requirements and outcomes in patients with PAH and atrial fibrillation (AF) receiving long-term anticoagulation. MATERIALS AND METHODS Patients initiated on warfarin for PAH between January 1, 2000 and December 31, 2008 were matched by warfarin initiation date (±90 days), age (±5 years), chronic disease score (±1 points), and sex to patients initiated for AF. The primary study endpoint was frequency of INR monitoring per 30 days of observation. Secondary endpoints included indicators of INR control and warfarin-related adverse events. RESULTS AND CONCLUSION A total of 84 patients were included - 18 and 66 in the PAH and AF groups, respectively. Patients with PAH had a higher median rate of INR measurements per 30 days compared to patients with AF (median=2.0, interquartile range [IQR]=1.5 - 2.3 vs. median=1.6, IQR=1.3 - 2.0, p=0.046). There were no differences between groups with respect to percent of INR measurements in range, overall time in therapeutic range (TTR), or warfarin-related adverse events (all p>0.05). Study results suggest that patients with PAH may be more difficult to manage as seen through more frequent INR monitoring. Potential management difficulties did not translate to a lower performance on indicators of INR control or increased risk of warfarin-related adverse events.