Ellen M. Schellhase

Collaborative partnership for clinical pharmacy services in Kenya.

PURPOSE A collaborative partnership for clinical pharmacy services in Kenya is described. SUMMARY Purdue University School of Pharmacy and Pharmaceutical Sciences (PUSOPPS) agreed to collaborate with the United States Agency for International Development-Academic Model for Providing Access to Healthcare (USAID-AMPATH) partnership to provide pharmacy services necessary for patients infected with human immunodeficiency virus (HIV) in Kenya. In addition to assisting Kenyan collaborators, the full-time, onsite faculty member from PUSOPPS serves as a preceptor to pharmacy clerkship students from PUSOPPS and the University of Nairobi in the delivery of clinical pharmacy services in inpatient and outpatient settings. Through PUSOPPSs unique collaboration, Kenyan pharmacy technologist students and University of Nairobi pharmacy students partner with clerkship students from PUSOPPS to participate in eight-week rotations. In addition to inpatient activities, students spend one day each week at one of the rural HIV clinics or observing one of the burgeoning specialized care clinics. Students also participate in public health activities, such as providing adherence counseling for HIV-infected patients, participating in door-to-door HIV counseling and testing, and preparing educational and recreational activities for pediatric patients. PUSOPPSs sustainable involvement with this program has addressed many of the immediate pharmacy needs of providing antiretroviral therapy and medications for opportunistic infections throughout western Kenya. CONCLUSION The collaboration between PUSOPPS and USAID-AMPATH in Eldoret, Kenya, has provided a bilateral educational exchange for Kenyan and American pharmacy students and has allowed for year-round clinical pharmacy services in both inpatient and outpatient settings.

The oncology pharmacy in cancer care delivery in a resource-constrained setting in western Kenya

The movement to deliver cancer care in resource-limited settings is gaining momentum, with particular emphasis on the creation of cost-effective, rational algorithms utilizing affordable chemotherapeutics to treat curable disease. The delivery of cancer care in resource-replete settings is a concerted effort by a team of multidisciplinary care providers. The oncology pharmacy, which is now considered integral to cancer care in resourced medical practice, developed over the last several decades in an effort to limit healthcare provider exposure to workplace hazards and to limit risk to patients. In developing cancer care services in resource-constrained settings, creation of oncology pharmacies can help to both mitigate the risks to practitioners and patients, and also limit the costs of cancer care and the environmental impact of chemotherapeutics. This article describes the experience and lessons learned in establishing a chemotherapy pharmacy in western Kenya.

Performance outcomes of a pharmacist-managed anticoagulation clinic in the rural, resource-constrained setting of Eldoret, Kenya

Summary.  Background: It is recommended that warfarin therapy should be managed through an anticoagulation monitoring service to minimize the risk of bleeding and subsequent thromboembolic events. There are few studies in Sub‐Saharan Africa that describe warfarin management in spite of the high incidence of venous thromboembolism (VTE) and rheumatic heart disease. Objective: To examine the feasibility of the Moi Teaching and Referral Hospital anticoagulation monitoring service and compare its performance with clinics in resource‐rich settings. Methods: A retrospective chart review compared the percentage time in the therapeutic range (TTR) and rates of bleeding and thromboembolic events to published performance targets using the inference on proportions test. Wilcoxon’s rank sum analyses were used to establish predictors of TTR. Results: For the 178 patients enrolled, the mean TTR was 64.6% whereas the rates of major bleeds and thromboembolic events per year were 1.25% and 5%, respectively. In the primary analysis, no statistically significant differences were found between the results of TTR, major bleeds and thromboembolic events for the clinic and published performance rates. In the secondary analysis, having an artificial heart valve and a duration of follow‐up of > 120 days were positively associated with a higher TTR (P < 0.05) whereas venous thromboembolism, history of tuberculosis, HIV and a duration of follow‐up of < 120 days were associated with having a lower TTR (P < 0.05). Conclusions: The performance of the MTRH anticoagulation clinic is non‐inferior to published metrics on the performance of clinics in resource‐rich settings.

Retrospective Analysis of the Efficacy of Gemcitabine for Previously Treated AIDS-Associated Kaposi's Sarcoma in Western Kenya

Objectives: Evaluation of outcomes in the use of single-agent gemcitabine for the treatment of AIDS-associated Kaposi’s sarcoma (KS) in a western Kenyan cancer treatment program. Methods: Retrospective chart review of all patients with KS treated with single agent gemcitabine following failure of first-line Adriamycin, bleomycin, and vincristine (ABV). Baseline demographics were collected, and clinicians’ assessments of response were utilized to fill out objective criteria for both response as well as symptom benefit assessment. Results: Twenty-three patients with KS who had previously failed first-line therapy with ABV were evaluated. Following treatment, 22 of the 23 patients responded positively to treatment with stable disease or better. Of the 18 patients who had completed therapy, with a median follow-up of 5 months, 12 patients had no documented progression. Conclusions: Treatment options in the resource-constrained setting are limited, both by financial constraints as well as the need to avoid myelotoxicity, which is associated with high morbidity in this treatment setting. This work shows that gemcitabine has promising activity in KS, with both objective responses and clinical benefit observed in this care setting. Gemcitabine as a single agent merits further investigation for AIDS-associated KS.

An elective pharmaceutical care course to prepare students for an advanced pharmacy practice experience in Kenya.

Objective. To develop a prerequisite elective course to prepare students for an advanced pharmacy practice experience (APPE) in Kenya. Design. The course addressed Kenyan culture, travel preparation, patient care, and disease-state management. Instructional formats used were small-group discussions and lectures, including some Web-based presentations by Kenyan pharmacists on disease states commonly treated in Kenya. Cultural activities include instruction in conversational and medical Kiswahili and reading of a novel related to global health programs. Assessment. Student performance was assessed using written care plans, quizzes, reflection papers, a formulary management exercise, and pre- and post-course assessments. Student feedback on course evaluations indicated that the course was well received and students felt prepared for the APPE. Conclusion. This course offered a unique opportunity for students to learn about pharmacy practice in global health and to apply previously acquired skills in a resource-constrained international setting. It prepares students to actively participate in clinical care activities during an international APPE.

Clinical Pharmacy Consultations Provided by American and Kenyan Pharmacy Students During an Acute Care Advanced Pharmacy Practice Experience

Objective. To compare the clinical consultations provided by American and Kenyan pharmacy students in an acute care setting in a developing country. Methods. The documented pharmacy consultation recommendations made by American and Kenyan pharmacy students during patient care rounds on an advanced pharmacy practice experience at a referral hospital in Kenya were reviewed and classified according to type of intervention and therapeutic area. Results. The Kenyan students documented more interventions than American students (16.7 vs. 12.0 interventions/day) and provided significantly more consultations regarding human immunodeficiency virus (HIV) and antibiotics. The top area of consultations provided by American students was cardiovascular diseases. Conclusions. American and Kenyan pharmacy students successfully providing clinical pharmacy consultations in a resource-constrained, acute-care practice setting suggests an important role for pharmacy students in the reconciliation of prescriber orders with medication administration records and in providing drug information.

Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists

Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations. Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching. Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program. Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.

Development and Implementation of a Tablet Splitting Education Program in a Veterans Affairs Medical Center

Tablet splitting offers several benefits to the patient and the health care system, including more specific and appropriate dosages and improved cost effectiveness. Tablet-splitting programs have been established in a variety of health care settings. The Roudebush VAMC in Indianapolis, Indiana, implemented a pilot program to educate patients about tablet splitting. Each patient was evaluated for ability to split tablets; eligible patients received comprehensive education on tablet splitting. Twelve pharmacy clerkship students from two universities carried out the program over seven nonconsecutive weeks. One hundred and three patient encounters were documented. The total cost savings from the interventions was

Effect of Time to Titration to Maximum Dose of Statins on Cardiovascular Outcomes

7986.32. A more comprehensive program has the potential to save

Effect of time to titration to maximum dose of statins on cardiovascular outcomes: a retrospective analysis in high-risk patients.

413,000 annually. The essential role of pharmacy students in this program demonstrated their importance in the provision of health care and patient education.