Deanne L. Hall

Health care expenditures and therapeutic outcomes of a pharmacist-managed anticoagulation service versus usual medical care.

Study Objective. To evaluate the differences in health care expenditures and therapeutic outcomes of patients receiving warfarin therapy management by a pharmacist‐managed anticoagulation service compared with those receiving warfarin management by usual medical care.

A comparison of educational interventions to enhance cultural competency in pharmacy students.

Objective. To determine the degree to which 3 different educational interventions enhance cultural competency in pharmacy students. Methods. Students were equally divided among a simulated-patient activity group, a written case-scenarios group, and a formal lecture group. Mean scores for pre- and post-intervention cultural self-assessment surveys were compared. Results. In the simulation group, there were significant positive changes in the cultural skills and cultural desire components; in the case-scenario group, there was a significant positive change in the cultural awareness component; and in the lecture group, there were significant positive changes in the cultural skills and cultural empathy components. With respect to the cultural skills component, there was greater post-intervention improvement in the simulation and lecture groups than in the case-scenario group. Conclusions. There were significant positive changes within each group, indicating that ideologies and behaviors may be altered based on the educational intervention received. However, a 1-hour practicum may not be sufficient to enhance cultural competency.

A Small Sample Randomized Clinical Trial Methodology Using N-of-1 Designs and Mixed Model Analysis

Background/Objectives: To date, research on substance abuse prevention relied extensively on large sample randomized clinical trials to evaluate intervention programs. These designs are appropriate for certain types of randomized prevention trials (e.g., efficacy or effectiveness for broad populations) but are unfeasible for other prevention science scenarios (e.g., rare pathologies, pilot studies, or replication tests at specific locales). Methods: An alternative randomized clinical trial is described that relies on much smaller samples, less resources than the large sample designs, randomization, N-of-1 designs for the intervention group, and mixed model analysis. Results: This methodology is illustrated using a small sample prevention study, which demonstrates its statistical power, flexibility, and sophistication for experimental testing of prevention-oriented research questions. Scientific Significance: This methodology can be applied to many existing prevention datasets to facilitate secondary analyses of existing datasets as well as novel studies. It is hoped that such efforts will include further development of the small sample design in substance abuse prevention contexts.

An introductory pharmacy practice experience providing pharmaceutical care to elderly patients.

Objective. To develop, integrate, and assess an introductory pharmacy practice experience (IPPE) in providing pharmaceutical care to patients at senior centers (Silver Scripts). Design. First-year pharmacy students learned and practiced the pharmaceutical care process in the classroom to prepare for participation in the Silver Scripts program, in which the students, under faculty mentorship, conducted comprehensive medication reviews for senior citizens attending senior centers in Pittsburgh, Pennsylvania. Assessment. Students, preceptors, and senior center staff members indicated the experience was positive. Specifically, first-year students felt they gained benefit both from an educational standpoint and in their own personal growth and development, while staff contacts indicated the patients appreciated the interaction with the students. Conclusion. The Silver Scripts experience is a model for linking classroom experiences and experiential learning. The cycle of experiencing, reflecting, and learning has provided not only a meaningful experience for our P1 students but also a worthwhile focused review of seniors’ medication use. This experience could be used as a model for other colleges and schools of pharmacy and their communities.

Evaluation of INR Monitoring Frequency and Time in Therapeutic Range

Background: Although anticoagulant therapy has been used for more than 50 years, the optimal interval between international normalized ratio (INR) measurements in patients who demonstrate a stable dose response remains unsettled. Based on the results of observational studies, the American College of Chest Physicians currently recommends that patients receiving a stable dose of warfarin undergo INR testing at least once every 4 weeks.1 Objective: To determine whether an increased frequency of INR monitoring impacts time in therapeutic range (TTR) among patients receiving maintenance warfarin therapy managed by an anticoagulation clinic. Methods: A total of 2,222 INR results belonging to more than 700 adults who were followed by the anticoagulation service at the University of Pittsburgh Medical Center and who were receiving maintenance warfarin therapy between April 1, 2006, and September 30, 2006, were retrospectively reviewed. INR measurements were categorized as having been determined fewer than 21 days or 21 or more days after the previous measurement, and the percentage of INRs within the therapeutic range was calculated for each interval. Results: During the evaluation period, INRs measured within 21 days of the preceding test were within the therapeutic range 75.1% of the time, whereas INRs obtained at least 21 days after the antecedent INR test were within the therapeutic range 79.9% of the time (p < 0.001). Additionally, the proportion of INRs below 1.5 or above 5.0 was not significantly different between the 2 groups, representing only 0.04% of all results at either interval (p > 0.05). Conclusions: Our evaluation suggests that more frequent INR monitoring among patients receiving maintenance warfarin does not impact TTR to a clinically meaningful extent. Moreover, these findings support the reevaluation of the anticoagulation service management algorithm to reduce the frequency of INR measurements among patients within the maintenance phase of therapy.

Changes in Student Performance and Confidence with a Standardized Patient and Standardized Colleague Interprofessional Activity.

Objective. To assess the impact of a standardized patient and standardized colleague interprofessional activity on student performance and perceived confidence in communicating with patients and physicians. Methods. Students in the third professional year were presented with a practice and final activity including a standardized patient interaction, SOAP note preparation, and standardized colleague interaction. Student performance was measured by assessment rubrics on practice and final activities. Students’ perceived confidence was measured via presurvey and postsurvey. Results. Students performed significantly better from the practice to the final activity with regard to communicating with patients, SOAP note, and the overall activity with a mean difference (95% CI) of 9.2 (6.9-11.5), 3.6 (1.3-5.8), and 3.9 (2.0-5.7), respectively. There was a positive significant change from presurvey to postsurvey in students’ confidence talking to patients and physicians on majority of questions. Conclusion. This study demonstrates that active learning and integrated assessments improve overall student performance. Integration of interprofessional education also has positive effects on students’ perceived confidence.

Evolution of ambulatory care pharmacy practice in the past 50 years

A recent article by Helling and Johnson,[1][1] published as part of the proceedings of the 2014 ASHP Ambulatory Care Summit, provides a chronology of many historical successes in ambulatory care pharmacy practice since the 1960s. As we approach the 75th anniversary of ASHP and celebrate the 50th

Implementation of a Medication Therapy Management Program in a Hospital-Based Outpatient Pharmacy

Purpose To describe the integration of a medication therapy management (MTM) service in a hospital-based outpatient pharmacy, including adapting Medicare-based screening criteria to target a primarily non-Medicare population, integrating data into the medical centers electronic medical record, and designing a method to track identified drug-related problems (DRPs). Methods The hospital-based outpatient pharmacy at the University of Pittsburgh Medical Center (UPMC) established an MTM service to enhance patient medication safety. Identification criteria were developed in accordance with the Medicare Modernization Act of 2003 and institutional practices: older than 65 years, more than 5 chronic medications, more than 3 chronic disease states, presence of diabetes, tobacco use, or possible adverse drug event (ADE). As this was a proof of concept pilot, both Medicare and non-Medicare patients were included. Additionally, an intervention tracking form was developed to use in conjunction with the medical centers electronic medical record. Results During an 18-month period, 319 patients met the criteria upon random screening. Sixty-eight patients enrolled in the MTM program, resulting in 234 patient visits. One hundred and seventy DRPs were identified, with 2.5 DRP per patient. The most common problems found were the need for additional drug therapy and nonadherence. The overall physician acceptance rate for recommendations was 69%. Conclusion MTM programs are adaptable to a hospital-based outpatient pharmacy utilizing Medicare-based screening criteria in a primarily non-Medicare population resulting in identification of DRPs.

Using the Pharmacist Interaction Tracking Tool for Capturing Student-Patient Interactions in Direct and Simulated Patient Care Activities

Objective. To create and implement a standardized data collection tool for capturing student-patient interactions in direct and simulated patient care activities. Design. Faculty members and students determined key elements, design, and an implementation plan for the tool, which was to be used by students across professional years to quantify numbers and types of interactions with patients for tracking student progression toward achievement of curricular outcomes. Assessment. During the 2013-2014 academic year, 27 778 entries were completed, with 17 767 (64%) advanced pharmacy practice experiences, 7272 (26%) introductory pharmacy practice experiences, and 2739 (10%) simulation. Direct patient care interactions occurred with 11 090 patients and 10 983 providers, with 14 252 drug-related problems identified. Data was used by students for their professional portfolios, by administrators for curricular assessment, and to student impact on patient care. Conclusion. The PITT Form enabled the collection of data from actual and simulated patient care activities, allowed for curricular assessment of activities across years, and was used by individual students.