Donna West

Inappropriate use of inhaled short acting beta-agonists and its association with patient health status

ABSTRACT Background: Despite the widespread distribution of guidelines on the proper use of inhaled asthma medication, the overuse of short acting bronchodilators (SABs) persists. This study aims to examine how inhaled asthma medications are used in the US and to examine whether inappropriate use of inhaled SABs is associated with poor patient health. Research design and methods: The study design was a retrospective analysis of the Medical Expenditure Panel Survey (MEPS) for asthmatic patients 5 years or older who had used SAB medication during the period from 1996 through 2000. Use of SAB medication was defined as inappropriate when a patient inhaled more than 225 defined daily doses (DDDs) of SABs but less than 45.625 DDDs of corticosteroids per year. Health status was evaluated using survey respondents’ perceptions on a 5‐point Likert scale. Five functional limitations (activities of daily living, instrumental activities of daily living, walking, social function, and cognitive function) were rated on a dichotomous scale. Results: A total of 2386 asthmatic patients were identified as having used a SAB in the period 1996 through 2000. Of these, 272 (11.4%) used excessive doses of SABs, and of this group of excessive users, 151 (55.5%) underused corticosteroids. Compared to appropriate users of SAB medication, inappropriate users had lower perceptions of their overall health (adjusted mean: 3.21 vs. 2.94, p < 0.05) and mental health (adjusted mean: 2.39 vs. 2.13, p < 0.05). They were also at an increased risk of limitations in walking (relative risk [RR]: 1.76, 95% confidence interval [CI]:1.15–2.71) and in cognitive function (RR: 2.32, 95% CI: 1.37–3.93). Conclusion: Despite the national guidelines concerning the proper use of inhaled asthma medication, over-reliance on SAB medication and under-use of corticosteroids persists in the US. Those not using asthma medication according to the guidelines had poor perceptions of their health and were subject to an increased risk of limitations in walking and cognitive function.

Web-based Multimedia Vignettes in Advanced Community Pharmacy Practice Experiences

Objectives. To evaluate the effectiveness of Web-based multimedia vignettes on complex drug administration techniques to augment the training of pharmacy students in advanced community pharmacy practice experiences. Design. During the orientation for a community APPE, students were randomly assigned to either a study group or control group After they began their APPE, students in the study group were given an Internet address to access multimedia vignettes which they were required to watch to augment their training and standardize their counseling of patients in the use of inhalers and ear and eye drops. Assessment. A 12-item questionnaire was administered to students in both groups at the orientation and again on the last day of the APPE to evaluate their knowledge of counseling patients in the use of inhalers and ear and eye drops. The control group did not experience any improvement in their counseling knowledge of the research topics during their month-long experience. Students in the intervention group scored higher on their postintervention test than students in the control group (p < 0.001). Conclusions. Student learning outcomes from experiential training can be improved through the use of Web-based multimedia instructional vignettes.

Prevalence and Treatment of Metabolic Syndrome in Adolescents with Type 2 Diabetes

Background: The incidence of obesity and type 2 diabetes among adolescents has risen dramatically in recent years, and it is likely that many of these adolescents also have metabolic syndrome. Objective: To investigate the prevalence of metabolic syndrome in the patient population enrolled in a childrens hospital type 2 diabetes clinic and to describe baseline pharmacologic treatment and adherence patterns. Methods: In this retrospective cohort study, the medical charts of 52 adolescents were reviewed. A data collection instrument was used to collect demographic data, laboratory values, medication lists, and documented adherence patterns from the patients initial clinic visit. Data collected were used to identify patients with metabolic syndrome. Data were entered into a database and analyzed using SPSS 13.0. Results: Data were collected for 52 patients; of these, 40 (76.9%) had characteristics of metabolic syndrome meeting 3 or more of the 5 criteria, although only 8 (15.4%) were diagnosed with the metabolic syndrome. Among patients with characteristics of metabolic syndrome, 92.5% were taking a glucose-lowering drug, with 85% of those receiving metformin. Sixteen (40%) patients were receiving a blood pressure–lowering medication at baseline, and 4 (10%) were taking a lipid-lowering agent. Forty-three percent of these patients reported nonadherence to their prescribed drugs. Conclusions: Given these treatment patterns, pharmacologic management of metabolic syndrome in adolescents with type 2 diabetes may be suboptimal and may impact cardiovascular outcomes. It is important for clinicians to be aware of the incidence of type 2 diabetes and metabolic syndrome in adolescents so that treatment with lifestyle modifications and pharmacologic therapy may be implemented earlier.

Perspectives on Educating Pharmacy Students About the Science of Safety

Objective. To identify opinions about pharmacy graduates’ science of safety (SoS) educational needs. Methods. Semi-structured interviews were performed with 25 educators and researchers at US pharmacy colleges and schools and 5 individuals from associations engaged in drug safety-related issues. Results. Themes that emerged from the 30 interviews with key informants included: pharmacists should meet minimum SoS requirements; medication safety education is inconsistent; and barriers exist to improving SoS curricula. Student deficiencies noted included the lack of: student acceptance of a “culture of safety”: ability to effectively communicate verbally about medication safety; knowledge of the drug development process; and quality improvement skills. Key informants did not agree on how to address these gaps. Conclusions. While educators, researchers, and other leaders in drug safety-related issues thought that US colleges and schools of pharmacy covered portions of SoS well, there were perceived deficiencies. Minimum standards should be set to assist with curricular adoption of SoS.

Arkansas pharmacists perceptions toward emergency contraception and nonprescription Plan B

Objective This study describes Arkansas pharmacists’ knowledge, attitudes, and beliefs regarding emergency contraception. Methods A cross-sectional survey was conducted among a convenience sample of pharmacists prior to a continuing education lecture. The 16-item survey included multiple choice and true/false questions to assess knowledge in addition to Likert-type scale questions regarding attitudes and beliefs. Frequency and descriptive statistics were calculated for all variables. Results Eighty-eight pharmacists completed the survey. A majority (73%) knew that Plan B had been FDA-approved for nonprescription use yet 42% believed that it works by disrupting a newly implanted ovum. On a scale from 1-5 where 5=strongly agree, the mean item score was 3.2 for whether emergency contraception should be available for nonprescription use with counseling and 1.6 for nonprescription use without counseling. When asked what they would do if presented with a request for emergency contraception, 45.8% indicated they would dispense the drug, 22.9% would refer the patient to another pharmacist or pharmacy, 3.6% would refuse to dispense, and 27.7% were not sure. Almost half (48.6%) did not believe they were competent instructing patients on the use of emergency contraception. Conclusions The results show that pharmacists could benefit from additional training on emergency contraception.

Educating Pharmacists on Ophthalmic- and Otic-Drop Administration Techniques Using Internet-Based Video Clips

In 2003, 3.22 billion prescriptions were dispensed in U.S. community pharmacies, including more than 39 million prescriptions dispensed for 19 different ophthalmic and otic drops.1 Patients must use ophthalmic and otic medications correctly to achieve optimal outcomes. One factor in ensuring proper use is provison of patient counseling. Pharmacists need to know how to administer drops correctly so that they can teach these skills to their patients. We developed Internet-based multimedia video clips to teach ophthalmic and otic drop administration techniques. These video clips have been shown to be useful in teaching student pharmacists the correct techniques.2 In doing so, our focus was to demonstrate how an Internet-based multimedia video clip could efficiently augment the knowledge base of pharmacists, providing an opportunity to improve their ability to counsel patients on the administration of ophthalmic and otic products. The 3.22 billion prescriptions dispensed in 2003 represents a significant increase from the 2.8 billion prescriptions dispensed 1999, and a 47% projected increase to 4.5 billion prescriptions is expected by 2010.3,4 In 2003, an estimated 132,289 community pharmacists were in practice (24,341 prescriptions per pharmacist), and the number of community pharmacists is expected to rise only 9.2% to 144,508 by 2010.4 In view of the current pharmacist shortage and the projected increase in prescription volume in the coming years, pharmacists face increased time constraints for patient counseling over what they currently experience. Efficient patient counseling will become even more important than it is now. Objectives