Jean T. Carter

Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: Mathematical modeling using a database of commercially-insured individuals

BACKGROUND Prescription drug abuse in the United States and elsewhere in the world is increasing at an alarming rate with non-medical opioid use, in particular, increasing to epidemic proportions over the past two decades. It is imperative to identify individuals most likely to develop opioid abuse or dependence to inform large-scale, targeted prevention efforts. METHODS The present investigation utilized a large commercial insurance claims database to identify demographic, mental health, physical health, and healthcare service utilization variables that differentiate persons who receive an opioid abuse or dependence diagnosis within two years of filling an opioid prescription (OUDs) from those who do not receive such a diagnosis within the same time frame (non-OUDs). RESULTS When compared to non-OUDs, OUDs were more likely to: (1) be male (59.9% vs. 44.2% for non-OUDs) and younger (M=37.9 vs. 47.7); (2) have a prescription history of more opioids (1.7 vs. 1.2), and more days supply of opioids (M=272.5, vs. M=33.2; (3) have prescriptions filled at more pharmacies (M=3.3 per year vs. M=1.3); (4) have greater rates of psychiatric disorders; (5) utilize more medical and psychiatric services; and (6) be prescribed more concomitant medications. A predictive model incorporating these findings was 79.5% concordant with actual OUDs in the data set. CONCLUSIONS Understanding correlates of OUD development can help to predict risk and inform prevention efforts.

Comparison of Intraoperative Periarticular Injections Versus Liposomal Bupivacaine as Part of a Multimodal Approach to Pain Management in Total Knee Arthroplasty

Background Total knee arthroplasty (TKA) has been shown to restore mobility, return an individual to activities of daily living, and improve quality of life. Nearly 80% of patients undergoing TKA report moderate to severe pain in the first 2 weeks following surgery. Methods A retrospective study was conducted in 103 patients who underwent TKA between October 12, 2014 and May 30, 2015 by a single surgeon at a small community hospital. During this period, data were analyzed for differences in outcomes with a change from intraoperative periarticular (IOPA) injections containing an anesthetic/analgesic mixture of ropivacaine, epinephrine, ketorolac, and clonidine to liposomal bupivacaine. Patient records were reviewed to extract study data including postoperative opioid use, length of stay (LOS), opioid-associated adverse events, and non-opioid analgesic use. Results No statistical differences were determined between groups for mean postoperative opiate usage in morphine equivalences during any time frame or for total opiate usage (79.4 vs 89.2 mg; P = .259) during the first 72 postoperative hours. Patients who received a liposomal bupivacaine injection did have a statistically significant increase in hospital LOS (70.0 vs 75.5 hours; P = .013) when compared to patients who received an IOPA injection. The incidence of nausea or vomiting, pruritus, or oversedation did not differ between groups. Conclusion Pain control in TKA with a multimodal pain management protocol was not improved with the addition of liposomal bupivacaine compared to the IOPA injection at a community hospital.

The Role of Curriculum Committees in Pharmacy Education

Objective. To conduct a follow-up survey of curriculum committee chairs in US colleges and schools of pharmacy to describe current committee structures and functions and determine whether changes have occurred over time. Methods. A descriptive cross-sectional study design using a 30-item survey instrument regarding the structure, function, and charges of curriculum committees was sent to 100 curriculum committee chairs. Several new variables were added to the questionnaire to explore the use of systematic reviews, oversight of experiential education, and the impact of accreditation standards on work focus. Results. Eighty-five chairs responded. Curriculum committees are on average 1 person larger, less likely to have a student vote, more likely to have formal charges, and more likely to be involved in implementing an outcomes-based curriculum compared with 1994. Committees have shifted their work focus from review of curricular content to curricular revision. Conclusions. Curriculum committees continue to evolve as they respond to changes in pharmacy education and accreditation standards.

Formalization of an antimicrobial stewardship program in a small community hospital

Purpose. Results of a study to formalize an antimicrobial stewardship program (ASP) in a small community hospital are presented. Methods. The formalization process began with a gap analysis of the hospital’s antimicrobial services, followed by the development of a fully integrated, multipharmacist ASP. The impact was studied with an institutional review board‐approved study design. Retrospective pre‐ASP data were pulled from March 1 to June 30, 2012 and 2013 patient records; prospective post‐ASP data were collected for March 1 to June 30, 2015. Analyses included descriptive and inferential statistics. Results. No significant differences in age, percent of patients on antimicrobials, or length of stay were found between the 2 groups. The post‐ASP period showed a 30.2% decrease in defined daily dose (DDD) per 1,000 patient‐days for the 18 most frequently used parenteral antimicrobial agents (p < 0.001). For all nursing units except nursery, the vancomycin and piperacillin–tazobactam DDD per 1,000 patient‐days decreased by 63% (p < 0.001) and 36% (p < 0.001), respectively. Mean antibiotic charges per patient‐day decreased from

An Environmental Scan on the Status of Critical Thinking and Problem Solving Skills in Colleges/Schools of Pharmacy: Report of the 2009–2010 Academic Affairs Standing Committee

10.44 to

Experiential Education Delivery—Ensuring Success Through Support and Development of the Faculty and Administrative Team: Report of the 2004–2005 Professional Affairs Committee

3.09 (p < 0.001) and from

Algorithms for Estimating Learning Opportunity and Productivity Impact at Clerkship Sites.

18.04 to

Curricular and Financial Implications of PharmD Clerkship Placements 1

11.29 (p < 0.001) for vancomycin and piperacillin–tazobactam, respectively. Pharmacist interventions increased from 19.3 per 1,000 patients to 104.3 per 1,000 patients. Deescalation of therapy was the most common intervention (46% and 29%) in both time periods. Conclusion. In a small community hospital, a new formalized ASP with pharmacists showed a decrease in the DDD per 1,000 patient‐days and average antibiotic charges per patient‐day for vancomycin and piperacillin–tazobactam within 4 months of implementation. The approach used to develop a formalized ASP could be used as an example for development in small community hospitals with similar resources.