Karen Bastianelli

Point-of-care screenings at the University of Minnesota: Mechanism for civic engagement

OBJECTIVES To describe Wellness Initiative of the Northland (WIN) screening events; present participant results from those events; discuss the benefits of pharmacist-conducted, community-based point-of-care (POC) testing to medically underserved patients and to the profession of pharmacy; and describe logistical considerations in launching disease screening services. SETTING Pharmacist-led community health fairs in a variety of settings, including shopping malls, churches, community pharmacies, senior residence facilities, critical-access hospitals, and clinics. PRACTICE DESCRIPTION Disease screenings for economically disadvantaged residents of northeastern Minnesota and northwest Wisconsin, held between 2005 and 2012, through WIN. PRACTICE INNOVATION Mobile POC screenings for dyslipidemia, diabetes, hypertension, and osteoporosis. MAIN OUTCOME MEASURE Percentage of screenings with out-of-range readings. RESULTS Since 2005, WIN screenings have served more than 2,000 individuals, providing 4,152 POC screenings. Out-of-range readings were obtained for 40.3% of fingerstick cholesterol tests, 24.8% of fingerstick blood glucose tests, 24.3% of blood pressure tests, and 38.7% of quantitative ultrasound heel bone density readings. CONCLUSION Community-conducted POC testing functions both as an important public health service and a mechanism by which pharmacists and student pharmacists can become involved in civic engagement.

Comparing the Accuracy of 2 Point-of-Care Lipid Testing Devices

Background: Device manufacturers have improved technology since studies were last published, thus warranting an updated analysis. Objective: Two point-of-care (POC) cholesterol testing devices were directly compared to a venous sample to determine device accuracy. Methods: Institutional review board (IRB)–approved study collected finger-stick blood samples analyzed by Cholestech LDX (Cholestech Corporation, Hayward, California) and CardioChek Plus (Polymer Technology Systems Inc, Indianapolis, Indiana) devices and compared to venous blood for 30 study participants. Statistical analyses were completed using StatisPro. Intraclass correlation coefficients were generated, and the average difference expected to be within the industry standards of total cholesterol (TC; ±10%), high-density lipoprotein (HDL) cholesterol (±12%), and triglycerides (TG; ±15%). Results: The POC devices produced clinically equivalent values when compared to the same patients’ samples analyzed in a reference laboratory. The average difference calculated from the actual individual paired percentage bias with the Integra analyzer: venous—TC −3.8%, HDL −6.9%, TG −1.8%; CardioChek—TC −7.8%, HDL −6.2%, TG 5.1%; and Cholestech—TC 0.5%, HDL −4.5%, TG −3.3%. The average of the actual paired percentage bias with the Roche Cobas analyzer: CardioChek—TC −4.2%, HDL 0.8%, TG 7.0% and Cholestech—TC 4.6%, HDL 2.6%, TG −1.6%. Conclusion: Both screening devices operated within industry accuracy standards.

Naloxone Administration for Opioid Overdose Reversal in the Prehospital Setting: Implications for Pharmacists:

Background: Fatalities from opioid overdose have risen by 117% over the past 10 years. Increasing access to the opioid antagonist, naloxone can combat this trend and saves lives. This study investigates the various routes of naloxone administration for opioid reversal in the prehospital setting. Methods: PubMed, Ovid, and Google Scholar were searched for references that included the words naloxone and prehospital. Inclusion criteria were peer reviewed publications after 1995, English language, studies conducted in an outpatient setting, and intramuscular, intranasal, intravenous, or subcutaneous formulations; exclusion criteria were review articles or editorials. Results: 8 articles met the inclusion criteria: intramuscular, intranasal, intravenous, and subcutaneous dosage forms of naloxone were analyzed to compare their time to administration, time to efficacy, financial impact, administrator safety, and administrator preference. Conclusion: There is little consensus on the optimal route of naloxone administration in the prehospital setting. Little training is required for proper administration of the intramuscular auto-injector; however, the high price of this device is a barrier to access. Intranasal naloxone appears to be the optimal dosage form when considering cost, effectiveness, and administrator safety. Pharmacists must be aware of trends in naloxone use, dosage forms, and administration when caring for patients and their communities.

Evolution of self-care education

During the past 15 years, the curriculum content for nonprescription medication and self-care therapeutics has expanded significantly. Self-care courses ranging from stand-alone, required courses to therapeutic content and skills laboratories, have evolved in colleges and schools of pharmacy to accommodate rapid changes related to nonprescription medications and to meet the needs of students. The design of and content delivery methods used in self-care courses vary among institutions. Teaching innovations such as team-based learning, role playing/vignettes, videos, and social media, as well as interdisciplinary learning have enhanced delivery of this content. Given that faculty members train future pharmacists, they should be familiar with the new paradigms of Nonprescription Safe Use Regulatory Expansion (NSURE) Initiative, nonprescription medications for chronic diseases, and the growing trends of health and wellness in advancing patient-care initiatives. This paper reviews the significant changes that may be impacting self-care curriculums in the United States.

Nonprescription naloxone: Pros and cons

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Living an Educational Mission to Meet the Needs of Community and Public Health: Community Engagement in Pharmacy Education:

The Pharmacy Practice and Pharmaceutical Sciences (PPPS) department on the Duluth campus of the University of Minnesota College of Pharmacy (COP) was established in 2004 to meet the health-related needs of greater Minnesota with a mission to continuously improve “interdisciplinary pharmaceutical care education, research, practice and service focused on the health and well-being of underserved, rural, and indigenous communities.” In alignment with the PPPS mission and Boyer’s model of engaged scholarship, students and faculty have partnered with local communities through outreach events that have had a lasting impact on community health. Student-led programming can play a vital role in community and public health through health fairs and outreach activities that target the homeless, underserved, vulnerable communities, and individuals of all ages ranging from childhood to elderly. Over the past 10 years, these outreach events led by pharmacy students and faculty at the COP have provided educational and health-related services to more than 5,000 community members in northern Minnesota while providing valuable learning opportunities for students, faculty, and pharmacist preceptors.