Ana L. Hincapie

The Impact of Health Information Exchange on Health Outcomes

BACKGROUND AND OBJECTIVE Healthcare professionals, industry and policy makers have identified Health Information Exchange (HIE) as a solution to improve patient safety and overall quality of care. The potential benefits of HIE on healthcare have fostered its implementation and adoption in the United States. However,there is a dearth of publications that demonstrate HIE effectiveness. The purpose of this review was to identify and describe evidence of HIE impact on healthcare outcomes. METHODS A database search was conducted. The inclusion criteria included original investigations in English that focused on a HIE outcome evaluation. Two independent investigators reviewed the articles. A qualitative coding approach was used to analyze the data. RESULTS Out of 207 abstracts retrieved, five articles met the inclusion criteria. Of these, 3 were randomized controlled trials, 1 involved retrospective review of data, and 1 was a prospective study. We found that HIE benefits on healthcare outcomes are still sparsely evaluated, and that among the measurements used to evaluate HIE healthcare utilization is the most widely used. CONCLUSIONS Outcomes evaluation is required to give healthcare providers and policy-makers evidence to incorporate in decision-making processes. This review showed a dearth of HIE outcomes data in the published peer reviewed literature so more research in this area is needed. Future HIE evaluations with different levels of interoperability should incorporate a framework that allows a detailed examination of HIE outcomes that are likely to positively affect care.

Assessing Risks of Impaired Healing and Osteomyelitis Associated with Bisphosphonates Using FDA Adverse Event Reporting System (FAERS)

Objective: Bisphosphonates are the leading class of drugs to prevent and treat osteoporosis. Numerous cases of bisphosphonates related to bone necrosis and bone fractures have been reported. In this study the risks of impaired healing and osteomyelitis associated with bisphosphonates were assessed using case reports submitted to the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Methods: Using FAERS the adverse events reports from the first quarter of 2004 to the second quarter of 2012 associated with bisphosphonates and non-bisphosphonates anti-osteoporosis drugs were generated and evaluated. Standardized pharmacovigilance tools were applied to detect the signal of impaired healing and osteoporosis. Results: Among 14493 total reported events of impaired healing in FAERS, 49% of the cases were associated with use of bisphophonates. Substantial and pharmacovigilantly significant signals of impaired healing (PRR=13.39) and osteomyelitis (PRR=7.06) were detected. There was less risk of impaired healing (PRR=4.8) and osteomyelitis (PRR=1.61) associated with ibandronate (PRR=4.80) compared to other bisphosphonates. Interestingly weak but significant signals of impaired healing (PRR=3.40) and osteomyelitis (PRR=2.38) were also detected for denosumab. There were no significant risks of impaired healing (PRR=1.85) and osteomyelitis (PRR=0.25) associated with teriparatide. Conclusion: This study for the first time signals an increasing risk of impaired healing and osteomyelitis associated with bisphosphonates using FAERS. It has significant implication for patient safety in pharmacy practice. Considering the limitation of FAERS, such as under reporting, reporting bias and Weber-effect, this study provides goal for future large pharmacoepidemiologic studies.

Job satisfaction among chain community pharmacists: results from a pilot study

Objective The objectives of this study were to obtain pilot data concerning the job satisfaction of Tucson area retail chain setting and to identify the facets of community practice that have the greatest contribution to job satisfaction Methods This was a cross-sectional study of chain pharmacists in the Tucson area. The Warr-Cook-Wall questionnaire of job satisfaction was used to evaluate community pharmacists’ satisfaction with their current position. This study used Rasch analysis to assess the validity and reliability of the questionnaire. The Rasch scores obtained for each respondent were used as a dependent variable in univariate and bivariate analyses to evaluate differences in job satisfaction. Results A total of 32 pharmacists responded from 129 chain community pharmacies in the cities of Tucson, Marana and Oro Valley, Arizona. The mean (SD) Rasch score for job satisfaction was 0.93 (2.1). Results from bivariate analysis indicate that pharmacists in the Tucson area with practice experience outside community pharmacy were less satisfied with their job compared to those without experience outside community pharmacy (p<0.01). Conclusions This pilot evaluation suggests that having pharmacy experience outside community practice affects pharmacist job satisfaction. Additionally, findings from this study indicate that there is reliability and validity evidence to support the use of the modified Warr-Cook-Wall questionnaire for assessing overall job satisfaction in chain community pharmacy practice.

Incorporating Health Information Technology and Pharmacy Informatics in a Pharmacy Professional Didactic Curriculum -with a Team-based Learning Approach

Objective. To incorporate a pharmacy informatics program in the didactic curriculum of a team-based learning institution and to assess students’ knowledge of and confidence with health informatics during the course. Design. A previously developed online pharmacy informatics course was adapted and implemented into a team-based learning (TBL) 3-credit-hour drug information course for doctor of pharmacy (PharmD) students in their second didactic year. During a period of five weeks (15 contact hours), students used the online pharmacy informatics modules as part of their readiness assurance process. Additional material was developed to comply with the TBL principles. Online pre/postsurveys were administered to evaluate knowledge gained and students’ perceptions of the informatics program. Assessment. Eighty-three second-year students (84% response rate) completed the surveys. Participants’ knowledge of electronic health records, computerized physician order entry, pharmacy information systems, and clinical decision support was significantly improved. Additionally, their confidence significantly improved in terms of describing health informatics terminology, describing the benefits and barriers of using health information technology, and understanding reasons for systematically processing health information. Conclusion. Students responded favorably to the incorporation of pharmacy informatics content into a drug information course using a TBL approach. Students met the learning objectives of seven thematic areas and had positive attitudes toward the course after its completion.

Assessment of students’ satisfaction with a student-led team-based learning course

Purpose: To date, no studies in the literature have examined student delivery of team-based learning (TBL) modules in the classroom. We aimed to assess student perceptions of a student-led TBL elective. Methods: Third-year pharmacy students were assigned topics in teams and developed learning objectives, a 15-minute mini-lecture, and a TBL application exercise and presented them to student colleagues. Students completed a survey upon completion of the course and participated in a focus group discussion to share their views on learning. Results: The majority of students (n=23/30) agreed that creating TBL modules enhanced their understanding of concepts, improved their self-directed learning skills (n=26/30), and improved their comprehension of TBL pedagogy (n=27/30). However, 60% disagreed with incorporating student-generated TBL modules into core curricular classes. Focus group data identified student-perceived barriers to success in the elective, in particular the development of TBL application exercises. Conclusion: This study provides evidence that students positively perceived student-led TBL as encouraging proactive learning from peer-to-peer teaching.

An analysis of quality improvement education at US colleges of pharmacy

Objective. Analyze quality improvement (QI) education across US pharmacy programs. Methods. This was a two stage cross-sectional study that inspected each accredited school website for published QI curriculum or related content, and e-mailed a questionnaire to each school asking about QI curriculum or content. T-test and chi square were used for analysis with an alpha a priori set at .05. Results. Sixty responses (47% response rate) revealed the least-covered QI topics: quality dashboards /sentinel systems (30%); six-sigma or other QI methodologies (45%); safety and quality measures (57%); Medicare Star measures and payment incentives (58%); and how to implement changes to improve quality (60%). More private institutions covered Adverse Drug Events than public institutions and required a dedicated QI class; however, required QI projects were more often reported by public institutions. Conclusion. Despite the need for pharmacists to understand QI, it is not covered well in school curricula.

Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993–2015

Importance While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates. Objective The aim of this study was to determine the rate of community pharmacy dispensing errors in the USA. Methods English language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Studies with a denominator reflecting the total number of prescriptions in the sample were necessary for inclusion in the meta-analysis. A random effects meta-analysis was conducted to estimate an aggregate community pharmacy dispensing error rate. Heterogeneity was assessed using the I2 statistic prior to analysis. Results The search yielded a total of 8490 records, of which 11 articles were included in the systematic review. Two articles did not have adequate data components to be included in the meta-analysis. Dispensing error rates ranged from 0.00003% (43/1 420 091) to 55% (55/100). The meta-analysis included 1 461 128 prescriptions. The overall community pharmacy dispensing error rate was estimated to be 0.015 (95% CI 0.014 to 0.018); however, significant heterogeneity was observed across studies (I2=99.6). Stratification by study error identification methodology was found to have a significant impact on dispensing error rate (p<0.001). Conclusion and relevance There are few published articles that describe community pharmacy dispensing error rates in the USA. Thus, there is limited information about the current rate of community pharmacy dispensing errors. A robust investigation is needed to assess dispensing error rates in the USA to assess the nature and magnitude of the problem and establish prevention strategies.

Exploring Perceived Barriers to Medication Adherence and the Use of Mobile Technology in Underserved Patients With Chronic Conditions

Background and Objective: Evidence suggests that the prevalence of medication nonadherence is greater in medically underserved, low-income communities. There is paucity of qualitative data examining the potential use of mobile health (mHealth) in underserved patients. This study aimed to explore barriers to medication adherence and identify opportunities and challenges for the potential use of mHealth adherence interventions in an underserved population. Methods: A qualitative cross-sectional focus group was conducted. Focus groups were conducted with underserved patients recruited at a federally qualified health center. The Health Belief Model was used as theoretical framework to develop the focus group guide. Audio-recorded data were transcribed and thematically analyzed to identify common themes across the data set. Results: Seventeen patients participated in 4 focus groups. Findings were organized by the following themes: (1) perceived barriers to medication adherence, (2) everyday practices used to improve medication adherence, and (3) perceived benefits and barriers to technology use. Use of text messages seemed beneficial; however, not carrying a phone always was a significant barrier for patients. Some patients expressed willingness to try smartphone applications but stated that they would not be able to afford them. Changes in daily routine and complexity of medication regimens were seen as barriers to medication adherence. Conclusions: Findings underscore the importance of considering diverse experiences when engaging patients in mHealth for medication adherence. Providing patient-centered approaches to assist patients construct their individualized medication adherence strategies may lead to better outcomes.

Educating Pharmacists in Quality (EPIQ): Recipient, Academy for Healthcare Improvement 2015 Duncan Neuhauser Award for Curricular Innovation.

The Duncan Neuhauser Award for curriculum Innovation is presented annually at the Academy for Healthcare Improvement meeting. The award recognizes education providers that show innovation and improvement in advancing skills in health care. Duncan B. Neuhauser, PhD, a Senior Editor with the Quality Management in Health Care journal is a Professor of Health Services Research and the Charles Elton Blanchard Professor of Health Management at Case Western Reserve University. Dr Neuhauser has devoted his working life to the science of the improvement of health care and has served as a pioneer in the development of curriculum to promote health care improvement. The 2015 first place recipient was Educating Pharmacists in Quality (EPIQ) developed by the Pharmacy Quality Alliance. EPIQ was developed as a quality improvement education resource for use by pharmacy faculty and other professionals to teach students pharmacists, pharmacists, and other stakeholders about measuring, reporting, and improving quality in pharmacy practice. EPIQ has been integrated into more than 20 doctor of pharmacy curricula and has been used as part of employee training programs. Students and faculty members who have used the program have indicated via surveys that the program has a positive impact on awareness and knowledge of quality improvement in pharmacy.