Jamie L. McConaha

A Pharmacist’s Impact on 30-Day Readmission Rates When Compared to the Current Standard of Care Within a Patient-Centered Medical Home A Pilot Study

Objective: To evaluate the effect transition of care follow-up and counseling performed by a pharmacist, within a physician’s practice, can have on 30-day hospital readmissions among Medicare patients when compared to the current standard of care Methods: A pharmacist telephonically contacted patients ≥65 years with Medicare insurance following hospital discharge to perform medication reconciliation, review discharge instructions, and schedule a follow-up appointment (n = 34). At this follow-up appointment, the pharmacist reviewed the patient’s electronic medical record (EMR) and communicated recommendations to the physician. The current standard of care, which does not involve a pharmacist, at a similar local physician practice was used as a comparative group (n = 45) Results: The difference in 30-day readmission rates did not reach statistical significance (P = .27); however, there was a trending decrease in the percentage of patients readmitted between the control and the intervention groups (26.7% vs 14.7%). Additionally, there was nearly a statistically significant decrease in readmission rates for those patients who interacted with the pharmacist face to face versus only telephonically (P = .05) Conclusions: These results impact the decision to continue and expand the pilot program and demonstrate that pharmacists in the ambulatory setting based within a patient-centered medical home have a potential role in decreasing 30-day hospital readmissions.

Impact of the Fracture Risk Assessment on Patient and Physician Behavior in Osteoporosis Prevention

Objective: To evaluate the impact of a pharmacist-directed osteoporosis screening program utilizing the fracture risk assessment (FRAX) tool on patient and physician behavior. Methods: Postmenopausal women 45 to 65 years with Achilles T score <−1.0 not receiving bisphosphonate therapy were randomly assigned to a control or intervention group. All participants received a heel ultrasound and pharmacist education on risks of low bone mass. The intervention group received the FRAX and shared their results with their physician. Three months after screening, a telephonic questionnaire was administered to all participants. Results: A total of 749 patients were screened, with 87 meeting the enrollment criteria (43 control and 44 intervention). Physician behavior was not different between the groups with respect to ordering vitamin D levels, prescription medication, or dual-energy x-ray absorptiometry scan. A significant difference in vitamin D supplementation occurred between the 2 groups (P = .024). At follow-up, 72.2% of responding participants increased daily calcium intake and 76.4% started or increased physical activity. Conclusion: Physician behavior was not influenced by FRAX results in the intervention group; however, positive patient behavior changes occurred in both groups. Primary prevention efforts conducted through heel ultrasound screening and pharmacist consultation led women to follow-up; however, awareness still needs to be raised of the value of FRAX in osteoporosis prevention.

Influence of Viscosity and Consumer Use on Accuracy of Oral Medication Dosing Devices

Background: In response to numerous reports of overdoses with over-the-counter (OTC) liquid medications, the Food and Drug Administration has recommended that all OTC liquid drug products contain a measuring device but provided no recommendation on the type of device to be included. Objective: To evaluate the accuracy of liquid medication dosing devices (cup, dropper, syringe) in dispensing medications of varying viscosity in the laboratory and clinical settings. Methods: This experimental study evaluated dosing device accuracy. A pharmaceutics laboratory was used to evaluate accuracy under ideal conditions and subjects ≥18 years of age were recruited from community pharmacies to evaluate accuracy when used by consumers. Results: In the laboratory setting, the syringe was the most accurate for the more viscous formulations (cherry and grape suspension; 1% error, 1.2% error, respectively), and the dropper was the most accurate for the less viscous formulation (solution; 0.8% error). A volunteer sample of 320 participants was enrolled from the clinical setting. In the clinical setting, the syringe was most accurate, followed by the cup and then the dropper for all formulations (mean error, 2%, 14%, 33%, respectively). The cup was the most likely to overdose (mean, 5.7 mL), while the dropper was most likely to underdose (mean, 3.3 mL). Conclusions: The results of this study suggest that medication viscosity, consumer use, and dosing device contribute to dosing accuracy. The syringe appears to be the most accurate dosing device, accounting for differences in medication viscosity and the impact of consumer use.

Assessing Student Pharmacist Impact on Patient Over-the-Counter Medication Selection

Objective: To evaluate the financial and clinical outcomes of an over-the-counter (OTC) medication consultation performed by doctorate of pharmacy student pharmacists in a community pharmacy. Design: Cross-sectional survey. Setting: Independent and chain community pharmacy locations in Pittsburgh, Pennsylvania. Participants: Fourth professional year (PY4) advanced experiential student pharmacists on community rotations at the designated settings who performed OTC consultations and the participants of these encounters. Main Outcome Measured: Financial and clinical impact of an OTC consultation performed by student pharmacists on rotation. Results: A total of 559 OTC consultations were offered in 5 participating community pharmacy settings over a period of 1 year. Student pharmacists initiated 62.4% of all documented interactions and 60.5% of all participants accepted the consultation offer. The student pharmacists’ OTC recommendations resulted in significant cost savings to the participant. Those participants accepting consultation reported being more likely to consult with a pharmacist in the future. PY4 students were also able to demonstrate capability in impacting clinical outcomes on several occasions by implementing OTC medication changes due to patient safety concerns. Conclusion: Student pharmacist OTC consultations have the potential to positively impact both financial and clinical outcomes associated with the use of OTC medications.

The Effect of Caffeine and Choline Combinations on Short-term Visual and Auditory Memory

The purpose of this randomized control trial was to determine whether choline in combination with several doses of caffeine, could facilitate short-term visual and verbal memory and attention in adult and middle aged human subjects with normal cognitive function. The effects of several doses of caffeine in combination with choline on short-term visual and verbal memory, blood pressure and heart rate were assessed in 125 healthy adult and middle-aged men and women using six standardized tests from the Wide Range Assessment of Memory and Learning, Second Edition (WRAML 2). Tests included: Verbal Learning, Design Memory, Picture Memory, Story Memory, Finger Windows and Number/Letter. Group comparisons utilized one-way analysis of variance with Dunnett’s test post-hoc. Subjects administered caffeine 25 mg/choline 2 g scored significantly higher on tests for short-term visual memory than the placebo group. Conversely, the caffeine 50 mg/choline 2 g treatment group scored significantly lower on tests for short-term verbal memory and attention than the placebo group. There were no significant differences in memory test scores between men and women and no significant changes in blood pressure or heart rate following administration of any of the treatment combinations. These results suggest that oral caffeine 25 mg in combination with choline 2 g may enhance short-term memory in healthy adults without affecting cardiovascular function.