Jennifer Cerulli

Assessment of Drug-Related Problems in Clinical Nutrition Patients

BACKGROUND Medication use in clinical nutrition patients is affected by concomitant disease states and alterations in medication administration and delivery. The purpose of this evaluation was to document the number and type of drug-related problems that occurred and to evaluate the effect pharmacists had on the care of nutrition patients. METHODS Patients were evaluated by a pharmacist who was part of the clinical nutrition team. Drug-related problems were identified and recommendations were made to resolve them. Acceptance of the recommendations and patient outcomes were documented. RESULTS After the evaluation of 440 patients, 220 pharmacist interventions were made. Interventions included 35 drug information requests and 185 recommendations made to solve identified drug-related problems in 126 patients. The most frequent drug-related problems were drug interactions (33/185) and untreated indications (24/185). Of 185 recommendations, 166 were accepted, and 19 were accepted with a modification. A total of 132 of 155 recommendations that were accepted or accepted with modification had a positive outcome: 45 patients responded, and 87 patients developed no complications. Six patients did not respond to the recommendation, and in 17 patients the outcome was unknown. Fifty-eight recommendations avoided potential adverse drug events. CONCLUSIONS Pharmacist intervention identified drug-related problems in almost 30% of clinical nutrition patients. The identification and resolution of the problems had a positive effect on patient care, as indicated by patient outcome and the avoidance of adverse drug events. The drug-related problem approach identified areas in which pharmacists can educate the health care team and ensure proper medication use in this patient population.

Encouraging safe medication disposal through student pharmacist intervention

OBJECTIVES To (1) determine the publics current method of medication disposal, (2) identify the publics knowledge of the environmental impact of inappropriate medication disposal, (3) determine whether student-facilitated education improves the publics awareness of safe medication disposal, and (4) determine whether the public recognizes student pharmacists as a public health information resource for issues such as safe disposal of medications. DESIGN Cross sectional. SETTING Albany, NY, pharmacies during August and September 2009. PARTICIPANTS 242 patrons at 13 Albany College of Pharmacy and Health Sciences Community Pharmacy Advanced Pharmacy Practice Experience (CPAPPE) sites (2 mass merchandiser, 5 community chain, and 6 grocery store pharmacies). INTERVENTION Nine-question baseline and five-question postintervention anonymous surveys were administered to a convenience sample of store patrons 18 years of age or older. MAIN OUTCOME MEASURES Medication disposal practices before and after education, beliefs on the environmental importance of inappropriate disposal practices, and perceptions of student pharmacists as sources of information. RESULTS Students from CPAPPE sites completed 242 educational interventions. Respondents were primarily women (72%). At baseline, 12.8% of patients disposed of medication appropriately. Respondents frequently flushed medications down the toilet (27.2%) or incorrectly dumped medications in the trash (34.6%). Only 30.9% had received previous advice on safe medication disposal. Posteducation survey results indicated that 80.1% of respondents were willing to change their disposal methods. Increased numbers of respondents viewed inappropriate medication disposal as a moderate to substantial problem (from 57.2% preeducation to 83.9% posteducation). Of participants, 59.7% strongly agreed that student pharmacists were a good resource for information on safe medication disposal. CONCLUSION Additional public education on safe medication disposal is needed. Student pharmacists produced positive outcomes toward reducing this environmental and potential public health risk.

Community Pharmacy Target Intervention Program to Improve Aspirin Use in Persons with Diabetes

OBJECTIVE To identify the rate of aspirin or antiplatelet/anticoagulant use in persons with diabetes presenting to community pharmacies and determine whether a student pharmacist-driven Target Intervention Program (TIP) could increase the number of eligible persons with diabetes receiving aspirin therapy in accordance with American Diabetes Association (ADA) recommendations. DESIGN Unblinded, single intervention. SETTING Eight Community Pharmacy Advanced Practice Experience (CPAPE) sites in New York State. PARTICIPANTS Persons having prescriptions filled for diabetes medications or supplies who were not receiving antiplatelet/anticoagulant medications. INTERVENTIONS Assessment sheets were completed by student pharmacists for eligible patients to determine appropriateness for aspirin therapy. Recommendations for aspirin therapy were faxed to physicians when indicated, and physicians responded via fax for aspirin therapy implementation. The student pharmacists contacted patients, informed patients of physician decisions, and provided appropriate counseling. MAIN OUTCOME MEASURES Number of persons with diabetes currently receiving aspirin or antiplatelet/anticoagulant medications and the number initiated on aspirin as a result of the TIP. RESULTS A total of 436 persons with diabetes were identified. Of those contacted, 322 agreed to participate and 31 declined; 228 were taking aspirin or other antiplatelet/anticoagulant agents at baseline. Students completed assessment sheets, which were forwarded to physicians, for 79 subjects potentially eligible to receive aspirin therapy; 65 physician responses were received (82% response rate). Aspirin therapy was initiated in 53 patients (67%). CONCLUSION The TIP enabled CPAPE students to increase aspirin use among eligible persons with diabetes in accordance with ADA guidelines.

Outcomes of Pharmacological and Surgical Treatment for Obesity

The purpose of this article is to review the data from pharmacotherapeutic and surgical intervention studies for the management of obesity. Clinical outcomes assessed include weight changes over time and the effects of weight loss on blood pressure, serum lipid profiles and blood glucose control. Quality of life and economic data have been incorporated where available. Double-blind, randomised controlled trials were used preferentially over shorter term open studies. The literature evaluation was based on a Medline search of published data between January 1990 and January 1998.Obesity affects 65 million adults in the US. Estimates based on 1990 data suggest that obesity and comorbid illness contributed to

NSAID-avoidance education in community pharmacies for patients at high risk for acute kidney injury, upstate New York, 2011.

US46 billion in direct costs and

Comparison of the Achilles Express Ultrasonometer with Central Dual-Energy X-Ray Absorptiometry

US23 billion in indirect costs in the US.Obesity is a chronic condition which requires long term management. The risk of developing cardiovascular disease, hypertension, type 2 (non—insulindependent) diabetes mellitus, osteoarthritis, Pickwickian syndrome and cancer is increased in the obese population, resulting in excess morbidity and mortality. There are no long term prospective studies that have demonstrated that weight reduction in obese patients improves survival. However, on the basis of epidemiological data using the prevalence of disease and associated body mass index, it is generally accepted that weight reduction of 5 to 10% in obese patients is associated with significant health benefits.Current treatment modalities include diet and behaviour modification, exercise and, where indicated, pharmacological intervention. Surgical intervention is reserved for the clinically severe obese patient [body mass index (BMI) >40 kg/m2].Many studies have demonstrated weight loss and improved metabolic fitness over 6 to 12 months. Few studies have been conducted over a longer period. Limited data are available regarding reduced morbidity and mortality, improved quality of life and functional or employment status and even fewer have incorporated any economic assessments of the impact of medical or surgical intervention. Although prospective data have demonstrated reduced morbidity following surgical intervention, only retrospective data have demonstrated reduced mortality.Studies of new drugs and interventions under development should demonstrate long term safety and efficacy in terms of sustained weight loss and subsequent weight maintenance. Future studies should incorporate assessment of patient perceived satisfaction with weight loss, health status and quality-of-life evaluations and pharmacoeconomic data to aid clinicians in the decision-making process in terms of weight management of their obese patients.

Defining the pharmacist role in the pandemic outbreak of novel H1N1 influenza

Introduction Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently associated with community-acquired acute kidney injury (AKI), a strong risk factor for development and progression of chronic kidney disease. Using access to prescription medication profiles, pharmacists can identify patients at high risk for NSAID-induced AKI. The primary objective of this analysis was to evaluate the effectiveness of a community pharmacy–based patient education program on patient knowledge of NSAID-associated renal safety concerns. Methods Patients receiving prescription medications for hypertension or diabetes mellitus were invited to participate in an educational program on the risks of NSAID use. A patient knowledge questionnaire (PKQ) consisting of 5 questions scored from 1 to 5 was completed before and after the intervention. Information was collected on age, race, sex, and frequency of NSAID use. Results A total of 152 participants (60% women) completed both the pre- and post-intervention questionnaire; average age was 54.6 (standard deviation [SD], 17.5). Mean pre-intervention PKQ score was 3.3 (SD, 1.4), and post-intervention score was 4.6 (SD, 0.9) (P = .002). Participants rated program usefulness (1 = not useful to 5 = extremely useful) as 4.2 (SD, 1.0). In addition, 48% reported current NSAID use and 67% reported that the program encouraged them to limit their use. Conclusion NSAID use was common among patients at high risk for AKI. A brief educational intervention in a community pharmacy improved patient knowledge on NSAID-associated risks. Pharmacists practicing in the community can partner with primary care providers in the medical home model to educate patients at risk for AKI.

Does the health status of intimate partner violence victims warrant pharmacies as portals for public health promotion

Background: Quantitative ultrasound (QUS) devices provide portable, easy-to-operate, low-cost options for point-of-care screening of bone mineral density (BMD). Community pharmacists should be aware of the precision, sensitivity, and specificity of these devices prior to their purchase. Objective: To determine the precision, sensitivity, and specificity of the Achilles Express ultrasonometer compared with central dual-energy X-ray absorptiometry (cDXA) as well as its utility as a bone density screening device in the community pharmacy setting. Methods: A prospective study in a community pharmacy and outpatient ambulatory clinic was conducted with 2 groups of white women. Group 1 participants were 25–35 years of age (young, healthy), and those in Group 2 were 45 years of age or older (postmenopausal). BMD assessments of the spine and the nondominant wrist and hip were performed using cDXA. Assessments of the heel were performed using the Achilles Express, a QUS device. The main outcome measures were correlation of t-scores between cDXA and QUS measurements using the Pearson correlation test. Results: Twenty-two (30 ± 4 years of age) and 31 (55 ± 17 years of age) women were enrolled into Groups 1 and 2, respectively. Significant correlations between QUS and hip and spine cDXA t-scores were found in both groups. Correlation coefficients for QUS versus hip cDXA were 0.51 (95% CI 0.11 to 0.77) and 0.70 (95% CI 0.46 to 0.85) in Groups 1 and 2, respectively. Correlation coefficients for the QUS versus spine cDXA were 0.64 (95% CI 0.31 to 0.84) and 0.60 (95% CI 0.31 to 0.79) in Groups 1 and 2, respectively. The QUS device has a sensitivity level of 88% and specificity of 71% to detect a hip cDXA t-score of less than –1. Conclusions: The Achilles Express ultrasonometer is a reasonable screening tool to detect low BMD in postmenopausal women.

Update on the pharmacotherapy of obesity. 1998.

OBJECTIVES To assess patient knowledge about H1N1 influenza pandemic and vaccine availability, evaluate the effectiveness of student pharmacist education about H1N1 influenza, assess patient comfort with pharmacists as immunization providers, and identify patients preferred location for H1N1 vaccination. DESIGN Descriptive, nonexperimental, cross-sectional study. SETTING 18 community pharmacy advanced pharmacy practice experience (CP-APPE) sites located across New York State, from September 2009 to February 2010. PARTICIPANTS Convenience sample of adult (≥18 years of age) patients of CP-APPE sites. INTERVENTION Student pharmacists delivered an education intervention to patients and patients completed anonymous surveys. MAIN OUTCOME MEASURES Patient knowledge and comfort with pharmacists as immunizers. RESULTS 19 student pharmacists at 18 CP-APPE sites engaged in 215 interventions. The majority of respondents were women (60.9%) who were older than 60 years (43.7%) and white (83.7%). Patient knowledge and comfort with pharmacists as immunizers improved significantly. Compared with baseline, student pharmacist education interventions significantly increased the number of patients who were comfortable receiving the H1N1 influenza vaccination from a pharmacist (from 69.3% to 81.4%, P = 0.012). CONCLUSION Student pharmacists served as an effective education resource for patients regarding the H1N1 pandemic. Patient comfort with pharmacist provision of the H1N1 vaccination can enable pharmacists to serve as frontline health professionals in the time of a pandemic outbreak.

Experiential Education Builds Student Self-Confidence in Delivering Medication Therapy Management

OBJECTIVES To explore whether the health status of intimate partner violence (IPV) victims warrants pharmacies to be portals for public health promotion. Specific objectives included (1) identifying prevalence of IPV including domestic violence (DV) and sexual assault (SA) in a community sample, (2) describing characteristics and correlates of DV/SA between participants who reported and did not report DV/SA, and (3) exploring whether DV/SA status is related to mental health medication use. DESIGN Cross sectional. SETTING Upstate New York during 2006. PARTICIPANTS English- and Spanish-speaking respondents younger than 65 years of age answering four questions to assess DV/SA. INTERVENTION Secondary analysis of a countywide random telephone survey, the 2006 Monroe County Adult Health Survey, which collects prevalence data on health behaviors and health status indicators. MAIN OUTCOME MEASURE To determine whether those reporting DV/SA are at increased odds for mental health medication use, controlling for other sociodemographic- and health-related variables. RESULTS The survey response rate was 30.3%, with 1,881 respondents meeting inclusion criteria. Those reporting DV/SA were almost twice as likely to use mental health medications. However, when controlling for other variables, only poor mental and physical health were significant in increasing the odds of mental health medication use. CONCLUSION The analyses reported here suggest that DV/SA victims in a community sample use mental health medications. When controlling for other variables, survey respondents reported worse physical and mental health. If pharmacies are suitable portals for DV/SA outreach, curricula would need to provide the knowledge and skills needed to take an active role in this public health promotion.