Jennifer L. Rodis

Evaluation of Medication Adherence and Quality of Life in Patients With Hepatitis C Virus Receiving Combination Therapy

The purpose of this study was to identify medication adherence for patients infected with hepatitis C virus (HCV) referred to an interdisciplinary HCV education and monitoring service, evaluate changes in quality of life (QOL) and medication adherence during the first 3 months of HCV therapy, and determine relationships between adherence and QOL. Patients completed an initial survey before initiating the therapy evaluating medication adherence and QOL. They then received a structured training on HCV medications and monthly monitoring phone call from a pharmacist throughout the therapy. After 3 months of treatment, a follow-up survey was conducted to evaluate adherence, satisfaction, and QOL. Medication adherence was also assessed via patient self-report during follow-up phone calls. Patients expressed satisfaction with the care provided by the pharmacist and nurse practitioner individually and working collaboratively during their HCV therapy. Patients reported taking 99.8% of total interferon and ribavirin doses during the first 3 months of the therapy. Patients who indicated that they sometimes stopped taking medication when they felt worse had higher median aggregate physical functioning scores (p = .04) and those with no comorbidities found dosage times more inconvenient than those with at least one comorbidity (p = .046). Patients in a pharmacist-run HCV education service have high self-reported adherence rates and are satisfied with the interdisciplinary model of care. Quality of life may be associated with adherence; higher functioning, healthier patients may be more likely to stop taking HCV medications owing to side effects or inconvenience.

Practice-based research network as a research training model for community/ambulatory pharmacy residents

OBJECTIVE To describe our experience with a practice-based research training network (PBRTN) in a 1-year residency program. SETTING Ohio State University in Columbus from 1997 to 2007. PRACTICE DESCRIPTION The program includes two accredited postgraduate year 1 residencies and one postgraduate year 2 residency. Seven residents, 11 preceptors, and three faculty members participated during the time frame discussed in this article. Practice settings included three community sites and three ambulatory sites. PRACTICE INNOVATION The PBRTN includes a residency director, a research director, preceptor and resident members, and research faculty. The group works collaboratively to meet training goals. The PBRTN maintains a project timeline, foundational training, and structured research development, implementation, and presentation phases. Each resident submits five required research products: abstract, grant, poster, podium presentation, and research manuscript. MAIN OUTCOME MEASURES Quantitative measures included the number of abstracts, grants, and peer-reviewed publications over two time periods, one before and one after a deliberate attempt to increase the research focus of the residencies. The ratio of research products to number of residents was used as a measure of productivity. Postresidency career choice and postresidency publications are reported. RESULTS Over a decade, the program has produced 37 graduates, 50 abstracts, 15 grants, and 12 peer-reviewed publications. The publication-to-resident ratio increased from 0.25 in the pre-emphasis period of 1997-2001 to 0.56 in 2002-2007, after the research focus was intensified. Of graduates, 38% are in faculty positions, with 48 postresidency publications. CONCLUSION Use of a PBRTN has successfully provided research training and improved research outcomes for the program. This model could be implemented in other residencies.

Current trends in outpatient pharmacy services and billing

OBJECTIVES To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services. DESIGN Cross-sectional study. SETTING United States, February 2011. PARTICIPANTS Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community. INTERVENTION Online survey. MAIN OUTCOME MEASURES Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing. RESULTS MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002). CONCLUSION A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.

Assessment of pharmacy faculty members' opinions regarding required postgraduate pharmacy residencies.

PURPOSE Agreement between pharmacy faculty members and the American College of Clinical Pharmacy (ACCP) recommendations regarding the requirement of residency training to provide direct patient care or attain a position in academia is discussed. METHODS Faculty members of the American Association of Colleges of Pharmacy participated in a survey administered by an online survey tool. The survey contained a variety of yes/no, multiple choice, and Likert scale questions. Participants were asked to disclose whether they agreed with the ACCP recommendations. Other data collected included faculty demographics, individual awareness of the ACCP position statement, and postgraduate training recommendations before receiving the survey. RESULTS The survey was sent to 2414 faculty members, and 623 (26%) of those responded. A majority of the respondents (74.8%) identified themselves as pharmacy practice faculty. Of those who replied, 55.6% agreed that one year of residency training should be required to provide direct patient care. Approximately 64% agreed that a postgraduate year 1 residency should be required in order to be appointed as adjunct clinical faculty or preceptor of pharmacy students, while 50.1% agreed that two years of residency training should be required in order to be appointed to rank assistant professor. CONCLUSION A slight majority of faculty members responding to this survey agreed with recommendations in a 2006 ACCP position statement that proposed requiring residencies for all pharmacy students graduating from pharmacy school in order to attain positions in academia or settings providing direct patient care.

Risk factors and complications of subconjunctival hemorrhages in patients taking warfarin.

OBJECTIVES The aim of this study was to identify patients with subconjunctival hemorrhage (SCH) on warfarin therapy, to describe risk factors that may contribute to SCH development, and to identify complications related to SCH. METHODS A retrospective chart review was conducted including patients treated at a university anticoagulation clinic over 2 years (4,334 patient visits). Data collection included patient demographics; international normalized ratios (INRs) before, at time of, and after SCH; risk factors for increased risk of bleeding; patient-reported complications related to SCH; recent changes in medication use; and warfarin dosage adjustments made in response to the event. The data were summarized using descriptive statistics and frequencies described as percentages. RESULTS Fifteen SCH events were identified at an event rate of 0.35%. Two were excluded because of related surgeries near the time of SCH events. The average patient age was 67.3 years (range, 51 to 82). A total of 76.9% (n = 10) of patients had INRs within the goal range at the appointment before reporting the SCH. A total of 46.2% (n = 6) of patients reported alterations in medication regimens during the month preceding SCH. Various patient conditions were documented that may increase the risk of SCH development. No ophthalmic complications were associated with SCHs. CONCLUSIONS An SCH event rate of 0.35% was identified. Many factors may have precipitated SCH; however, ophthalmic complications were uncommon.

Improving Chronic Disease Outcomes Through Medication Therapy Management in Federally Qualified Health Centers

Introduction: Appropriate management of chronic diseases, including proper use of medications, can lead to better disease control, decrease disease-related complications, and improve overall health. Pharmacists have been shown to positively affect chronic disease outcomes through medication therapy management (MTM). The primary objectives of this project are to increase the number of patients with (1) A1c in control and (2) blood pressure in control; secondary objectives are to (3) describe number and type of medication-related problems identified and resolved by pharmacists providing MTM in Federally Qualified Health Centers (FQHCs), (4) identify potential (pADEs) and actual adverse drug events (ADEs), and refer patients to diabetes self-management education classes, as needed. Methods: This multisite, prospective, descriptive pilot study engaged three FQHC sites with distinct models of established pharmacist MTM services to care for patients with uncontrolled diabetes and/or hypertension. Data were reported in aggregate regarding primary and secondary outcomes. Results: As of December 2015, 706 patients were enrolled in the project. Of the 422 with uncontrolled diabetes, 52.84% (n = 223) had an A1c <9%; 72 patients (17.06%) achieved an A1c between 8% and 9%, 19.19% (n = 81) of patients achieved an A1c <8% and ≥7%, and 16.59% (n = 70) of patients achieved an A1c <7%. The percentage of patients with blood pressure <140/90 mm Hg improved to 65.21%. Conclusion: Pharmacist-provided MTM can improve chronic disease intermediate outcomes for medically underserved patients in FQHCs.

Pharmacy Residents' Pursuit of Academic Positions

Objective. To describe pharmacy residents’ interest in and pursuit of academic positions. Methods. An electronic presurvey and postsurvey were sent to pharmacy residents during the 2011-2012 residency year. The initial survey evaluated residents’ job preferences and interest in academia at the beginning of residency, and the follow-up survey focused on job selection and reasons for pursuing or not pursuing positions in academia. Results. Nine hundred thirty-six residents responded to the initial survey and 630 participated in both the initial and follow-up survey. Forty-eight percent of those responding to both surveys strongly considered a career in academia in the initial survey, 28% applied for an academic position, and 7% accepted a position. Second-year postgraduate residents were more likely than first-year postgraduate residents to apply for and be offered a faculty position. Conclusion. Pharmacy residents are interested in academia. While increasing interest among residents is encouraging for faculty recruitment, the academy should also encourage and develop adequate training experiences to prepare residents to succeed in these positions.

The feasibility of an inter-professional transitions of care service in an older adult population

Background Older adults discharged from the Emergency Department (ED) are at high risk for medication interactions and side effects; examples of practice models addressing this transition of care are lacking. Methods This was a prospective cohort study for adults in one of two urban community EDs. Patients ≥50 years of age discharged with at least one new, non‐schedule II prescription medication were included. Patients had the option of three transitions of care services: 1) pharmacist‐only with home delivery of discharge medications and full medication reconciliation, 2) pharmacist and home health care, including home delivery, medication reconciliation, and a visit from a home health nurse, or 3) either of the above without home delivery. Results Over seven months, 440 ED patients were screened. Of those, 43 patients were eligible, and three patients elected to join the study. All three patients selected pharmacy‐only. Identified barriers to enrollment include the rate of schedule II prescriptions from the ED (53% of potential patients) and high patient loyalty to their community pharmacist. Conclusions A pharmacy and home health care transitions of care program was not feasible at an urban community ED. While the pharmacist team identified and managed multiple medication issues, most patients did not qualify due to prescriptions ineligible for delivery. Patients did not want pharmacist or home health nurse involvement in their post ED visit care, many due to loyalty to their community pharmacy. Multiple barriers must be addressed to create a successful inter‐professional transition of care model.

A Faculty Member on Match Day

To the Editor. I wake before the alarm and stare at the ceiling for a bit. I am thinking about how many pharmacy students across the country are doing the same thing. It is 5:15 am on Match Day. In just a few short hours the fates of thousands of students and hundreds of residency programs will be sealed with an e-mail that will simply list the results of the Pharmacy Residency Match.1 As a faculty member who is involved with multiple residency programs at my institution, I am anxious for many reasons. My thoughts first go to the students who are the residency candidates. I have engaged in conversations with students all year regarding pieces of the puzzle that come together today. I have been talking about this day with some of these students since their first year in the pharmacy program. Others, I have just gotten to know during their final year at the college, as they are finding their path and gaining momentum to begin their career. I anticipate many of them will match, but I know that some of them will not. I sense their anticipation, for the complexities that they are not doing this by themselves, which provides security, competition, empathy, and jealousy. Friends and significant others will all find out at roughly the same time the great news, good news, or news that will leave them shocked, confused, and tearful. How will the news be shared? I assist with a Scramble Support program at the college of pharmacy; I field phone calls and e-mails from students who have not matched and are looking for advice and direction. Throughout the morning, I think about who I may be talking with during the day. I realize the possibility that there will be students at our institution who ranked our college of pharmacy-based programs and both the student and the program will find themselves in the scramble. As I arrive at work, I know the e-mails should come out in the next half hour. I am wondering which of these candidates will end up matching at our institution. Who will sit in the residency office just down the hall from me, serving as my immediate office suite community for the next year? How will my colleagues feel when the results come out? My office is next to the Residency Director for all of our college residencies, so I know how our program has fared as soon as it is released. The director and I celebrate and begin strategizing for one of the programs that did not match. Within 30 minutes after the e-mails arrive, I am receiving a call on my cell phone from a student who did not match. I also receive text messages and e-mails from students telling me they did match and where. I debrief with other faculty members throughout the morning regarding who has connected with which students who have and have not matched, as well as local and national residency programs that have not matched. The hallways are buzzing with faculty connecting, celebrating, and offering support for students who need it. I realize very little of the rest of my to-do list is going to get done today. The emotions with each phone call, e-mail, and hallway conversation go from excitement to pride to disappointment to surprise and around and around again. As I talk with students about the opportunity that presents through not matching, I am excited for them to be able to step out of the rat race and the linear career path they may have been following. I sincerely believe that not matching is the best thing that could happen for many if not all students. They get a chance to reflect and think completely differently about what they want next year and where they ultimately want to be, which is exciting and scary. It is too early for any of them or even me to fully embrace the optimism in these new prospects. We all need time to mourn, to feel the disappointment, and then to move forward purposefully. For me as a faculty member, I worry about how I prepared these students. Did I do everything I could to put them in a position to put their best selves forward through the residency application process? As I talk with students today, am I doing it the right way, in a way that tells them it’s OK to cry, but also encourages them to move forward thoughtfully? How can I do it better next year? By 3:00 pm, I am emotionally drained. How can I grumble about my emotions on this day? If I am spent, then I cannot imagine how they feel. I talk to another student who is trying to decide to scramble or not on my drive home. As the day comes to a close, I think about the next few days and the next week and what everyone (residency programs, candidates that matched, and those that didn’t) will be experiencing months from now – the next step.

Building capacity for pharmacist-provided patient care services.

training program to improve MtM capacity Pharmacy has been afforded many opportunities through the advent of the Medicare Modernization Act, medication therapy management (MTM) services, and, more recently, passage of the Affordable Care Act, leading critics and supporters to question whether capacity exists to support provision of direct patient care services by pharmacists, primarily in the community setting.1–3 Although research has shown that community pharmacists possess the clinical competency to provide MTM services,4 many community pharmacists yearning to engage in direct patient care services lack the time and training needed to develop them.5,6 Residency has been suggested as a required element of pharmacy education to ensure adequate preparation for the provision of direct patient care services.7 Although universal participation in residencies may be an ideal plan for developing future pharmacists, achieving this reality may not be feasible due to capacity limits and availability of open residency positions. Considering methods for training currently practicing pharmacists and students not able to complete residency is important, so that they may take advantage of current and future opportunities to provide direct patient care. The Ohio State University (OSU) College of Pharmacy (COP) Partner for Promotion (PFP) program was developed in 2005 to (1) enhance the skills and confidence of students and community pharmacy preceptors to deliver and expand direct patient care services in community pharmacies, (2) create sustainable direct patient care services in community pharmacies, and (3) increase the number of advanced pharmacy practice experience (APPE) sites for OSU COP. This program provides a systematic approach to enhancing direct patient care in community pharmacies through student-engaged service development. PFP partners APPE doctor of pharmacy students with preceptors at community pharmacies, and with training and mentoring by faculty at the college, these students and pharmacists work collaboratively through a 10-month experience to create and integrate a sustainable direct patient care service in the community pharmacy. Benefits to participants. Community pharmacies and pharmacists benefit from faculty expertise, trained students to work longitudinally with the pharmacy site, opportunities for formal training and continuing education, and continued support by OSU COP after initial involvement in the program through faculty consultation and student rotations. PFP offers students an opportunity to step outside the classroom and work through the process of service development in a real-life setting. Students gain additional benefit through practice and feedback from faculty related to time management, project management, and communication skills. OSU COP gains community pharmacy APPE sites able to provide student training in the provision of MTM services in the community.