Karen Gunning

Research in Women and Special Populations

The American College of Clinical Pharmacy charged a Task Force on Research in Special Populations to review, update, and broaden its 1993 White Paper on Women as Research Subjects. Participants of the task force included pharmacy clinicians and investigators in the field. This resulting White Paper, Research in Women and Special Populations, discusses the current concepts regarding the conduct of research in women, as well as in special populations such as children, elderly, minorities, cognitively impaired, and other vulnerable populations (e.g., prisoners and refugees). For each specific population, the barriers to research participation, current guidelines and regulations, and available recommendations to address these barriers are discussed. The participation in research by these populations requires addressing special social and ethical challenges. Clinical pharmacy researchers should be cognizant of these guidelines and be an advocate for the inclusion and the rights of women and special populations in research participation.

Impact of Pharmacist Previsit Input to Providers on Chronic Opioid Prescribing Safety

Introduction: Primary care providers (PCPs) account for half of opioid prescriptions, often feel chronic pain patients are challenging to manage, and there is wide variability in practice patterns. The purpose of this pilot study was to evaluate the impact of a previsit pharmacist review of high-risk patients treated with opioids for chronic pain on compliance to guideline recommendations at a family medicine residency clinic. Methods: All adult patients with an appointment for chronic pain who were prescribed >50 morphine milligram equivalents (MMEs)/day had charts reviewed by a pharmacist before each appointment; recommendations were sent electronically to the provider before the appointment. After 4 months of implementation, each patients chart was manually reviewed to gather outcome variables. The primary outcomes were the mean MMEs/day and pain scores. Results: Pharmacist previsit recommendations were provided for 45 patients. When comparing outcomes before and after intervention, the mean MMEs/day decreased by 14% (P < .001), with no change in pain scores (P = .783). Statistically significant improvements were noted in multiple other secondary opioid safety outcomes. Conclusion: Clinical pharmacists providing previsit recommendations was associated with decreased opioid utilization with no corresponding increase in pain scores and increased compliance to guideline recommendations.

Vaccination Rates in Patients With Medical Indications for the Pneumococcal Polysaccharide Vaccine in a Family Medicine Clinic

Background: Pneumococcal vaccination rates among high-risk patients (eg, diabetes, asthma, smoking) seen in 2 family medicine clinics are unknown. Objectives: To assess differences in pneumococcal polysaccharide vaccination rates and reasons for nonvaccination among patients with diabetes and asthma and patients who smoke. Methods: A chart review at 2 family medicine residency training clinics showed 425 patients with a medical indication for PPSV23 were seen between April 1, 2015, and April 30, 2015. One reviewer searched the electronic health records to assess reasons for nonvaccination. Results: Rates of nonvaccination were 29.8% in patients with diabetes, 58.7% in patients with asthma, and 62.5% in patients who smoke cigarettes. Patients were classified into 3 groups based on the reasons for nonvaccination: documented patient refusal, not being addressed by a provider, and being documented as low risk despite the presence of a medical indication. Conclusion: The 3 reasons for nonvaccination were vaccination not being addressed, misclassification of high-risk patients as low-risk patients for infection, and documented patient refusal. Providers overlooked vaccination more often in patients with asthma and cigarette use than in patients with diabetes. Patients seeing pharmacists were most likely to be vaccinated, whereas patients seeing physician assistants were least likely to be vaccinated. Pharmacists see patients to provide medication management and preventive care, whereas other providers treat more urgent conditions. Because indications are often overlooked and not addressed, pharmacists can play a larger role in identifying and vaccinating high-risk patients.

Achievement of Adequate Glycemic Control in Patients With Type 2 Diabetes and Comorbid Mental Health Conditions Treated in a Primary Care Setting

Objective. This study investigated the association between the presence of a mental health condition (MHC) diagnosis and glycemic control in patients with type 2 diabetes in a primary care clinic network. Methods. This retrospective cross-sectional study compared adequate glycemic control (A1C <8.0%) in patients with type 2 diabetes with and without any MHC, as well as by MHC subtypes of depression or anxiety, bipolar or schizophrenia disorders, and substance use disorder. Results. Of 3,025 patients with type 2 diabetes, 721 (24%) had a diagnosis for one or more MHC. The majority (54.9%) were <65 years of age, female (54.9%), and Caucasian (74.5%). Mean A1C was statistically lower in the MHC cohort at 7.14 ± 1.66% compared to 7.38 ± 1.73% in the group without any MHC (P = 0.001). Furthermore, those with an MHC were more likely to attain adequate glycemic control than those without an MHC (odds ratio 1.27, 95% CI 1.01–1.59). Among patients with MHCs, similar rates of adequate glycemic control were seen between those with depression or anxiety and those with other MHCs. However, fewer patients with substance use disorder had adequate glycemic control compared to those without this condition (66.7 vs. 80.10%, P = 0.004). Conclusion. Patients with diabetes and MHCs had slightly better glycemic control than those without any MHC. However, the presence of substance use disorder may present more barriers to adequate glycemic control. Additional research is needed to identify barriers unique to each MHC to optimize diabetes management in this population.