Kimberly Braxton Lloyd

Dispensing errors and counseling quality in 100 pharmacies

OBJECTIVE To evaluate the dispensing accuracy and counseling provided in community chain pharmacies. DESIGN Cross-sectional study. SETTING Community chain pharmacies in large metropolitan areas of Florida, Georgia, New Jersey, and New York. PARTICIPANTS Community chain pharmacies and trained shoppers. INTERVENTIONS Trained shoppers presented a new prescription order for one of five study drugs to each randomly selected pharmacy, and all encounters with pharmacy staff were recorded on video by ABC News 20/20 staff using hidden cameras. MAIN OUTCOME MEASURES Dispensing errors on prescriptions for selected medications were the indicator of prescription dispensing accuracy. Frequency of verbal counseling and information categories discussed or included in written information were used to assess the quality of counseling. RESULTS Of 100 prescriptions dispensed, 22 had one or more deviation from the physicians written order, for a 22% dispensing error rate. Three of the errors were judged to be potentially harmful when dispensed to a typical patient requiring these therapies. A total of 43 shoppers (43%) received verbal counseling, including 16 cases in which the shopper prompted counseling. All shoppers received written information with their prescription, covering an average of 90% of the required topics. Some 68% of the warfarin shoppers purchased aspirin without the pharmacist verbally warning about taking the drugs simultaneously. CONCLUSION The dispensing error rate of more than one in five prescriptions is similar to the rate found in a similar study conducted 14 years ago, but counseling frequency has decreased significantly during the period.

Complementary and Alternative Medications for Women’s Health Issues

Women often seek alternative treatment options such as herbs, dietary supplements, and vitamins and minerals to treat womens health issues across the lifespan. Women may use complementary and alternative supplements for dysmenorrhea, premenstrual syndrome, infertility, nausea and vomiting during pregnancy, and symptoms of menopause. In general, there is a deficit of well-designed, randomized, controlled trials to evaluate the efficacy and safety of complementary and alternative medicine for these indications, which makes it difficult to provide evidence-based recommendations. This review outlines the evidence for efficacy and safety that is currently available for dietary supplement use by women to manage health conditions specific to the female patient.

Comparing therapies for postmenopausal osteoporosis prevention and treatment

OBJECTIVE: To review the literature concerning the efficacy of calcium, hormone replacement therapy (HRT), bisphosphonates, selective estrogen receptor modulators, and calcitonin in the prevention and treatment of postmenopausal osteoporosis. DATA SOURCES: Articles were identified through searches of the MEDLINE (1966–July 2002), EMBASE (1980–July 2002), and International Pharmaceutical Abstracts (1970–July 2002) databases using the key words osteoporosis, postmenopausal, fracture, calcium, vitamin D, hormone replacement therapy, bisphosphonates, alendronate, risedronate, raloxifene, and calcitonin. Additional references were located through review of the bibliographies of the articles cited. Searches were not limited by time restriction, language, or human subject. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies of the use of calcium and antiresorptive therapies for the prevention and treatment of postmenopausal osteoporosis were selected. Articles evaluating bone mineral density (BMD) or fracture efficacy were included in this review. DATA SYNTHESIS: HRT, bisphosphonates, raloxifene, and calcitonin have demonstrated stabilization of and improvement in BMD. Randomized clinical trials have shown fracture risk reduction with bisphosphonates, raloxifene, HRT, calcium, and calcitonin. The largest risk reductions have been reported with use of bisphosphonates in several trials. CONCLUSIONS: Several therapeutic options with well-documented improvements in BMD and reductions in fracture risk are available to women for the prevention and treatment of postmenopausal osteoporosis.

Implementation of a Weight Management Pharmaceutical Care Service

Background: Obesity, a national epidemic, is one of the leading causes of preventable morbidity and mortality in the US. Pharmacists can play an integral role in weight management. Offering weight management services provides an opportunity to increase public awareness of pharmaceutical care and attract patients to pharmacy programs. Objective: To describe the implementation and evaluate outcomes of a weight management pharmaceutical care service in a stand alone pharmaceutical care center on a college campus. Methods: A retrospective review of data was conducted on 289 patient charts to evaluate the change in weight, body mass index (BMI), percent body fat, and weight-related health conditions in patients who participated in the Healthy Habits program. Results: The net change (change in values observed from first to last appointment) in weight was a loss of 1021.8 kg. The maximum weight change (change seen from the first appointment to the lowest value obtained during the program) was a loss of 1530.5 kg. These values correspond to a net mean weight loss of 3.6 kg per patient (10% of baseline weight) and a maximum mean weight loss per patient of 5.5 kg (15% of baseline weight). Eighty-three patients were able to decrease their BMI category and 76 patients had a decrease in risk status from baseline. Conclusions: The Auburn University Pharmaceutical Care Centers Healthy Habits program has been successful in helping patients decrease total body weight, BMI, and risk of weight-related complications. In addition, the program has increased the opportunity to identify other pharmaceutical care needs of patients and help establish the role of pharmacists in the management of obesity.

Effects of St. John's Wort Supplementation on Ibuprofen Pharmacokinetics

Background: St. Johns wort is a popular herbal supplement that has been involved in various herb–drug interactions. Experimental findings suggest that the supplement may impact CYP2C9 metabolism. CYP2C9 is responsible for the irreversible metabolism of ibuprofen, Objective: To examine the effect of 3 weeks of St. Johns wort administration on the stereoselective pharmacokinetics of ibuprofen. Methods: Eight male subjects participated in this study. The single-dose pharmacokinetics of ibuprofen were evaluated before and after 21 days of St. Johns wort administration. Plasma ibuprofen concentrations were determined, using a stereoselective, reversed-phase HPLC assay. Model independent methods were used to evaluate the pharmacokinetics of each ibuprofen enantiomer. Data were analyzed by 2 way ANOVA testing and confidence interval testing. Results: S(+)-ibuprofen mean ± SD AUC and maximum concentration (Cmax) values were 131.6 ± 26.8 μg•h/mL and 31.8 ± 7.33 μg/mL, respectively, for control samples and 122.4 ± 32.9 μg•h/mL and 33.6 ± 7.83 μg/mL, respectively, after St. Johns wort treatment. R(–)-ibuprofen mean AUC and Cmax values were 85.1 ± 26.6 μg•h/mL and 28.4 ± 8.72 μg/mL, respectively, for control samples and 87.7 ± 30.1 μg•h/mL and 30.0 ± 8.97 μg/mL, respectively, for St. Johns wort treatment samples. St. Johns wort administration resulted in no significant effects on the Cmax and AUC of either stereoisomer. A 31% decrease in S(+)-ibuprofen mean residence time (p = 0.02) was observed. Conclusions: St. Johns wort administration for 21 days had no apparent clinically important impact on the single-dose pharmacokinetic parameters of S(+)- and R(–)-ibuprofen. Although St. Johns wort treatment appears to significantly reduce the mean residence time of S-ibuprofen, no ibuprofen dose adjustments appear warranted when the drug is administered orally with St. Johns wort, due to the lack of significant change observed in ibuprofen AUC and Cmax for either enantiomer.

Devices for home evaluation of women's health concerns

PURPOSE Devices used for home evaluation of fertility, pregnancy, menopause, colon cancer, breast cancer, and urinary-tract and vaginal yeast infections are discussed. SUMMARY Ovulation-prediction devices monitor natural changes in a womans body during the menstrual cycle, including changes in basal body temperature, urinary luteinizing hormone, and urinary estrone-3-glucuronide concentrations. Also available are devices that identify changes in the content of sodium chloride and other electrolytes in saliva and cervical-vaginal mucus. Home pregnancy tests are designed to detect human chorionic gonadotropin in the urine. Both urine and saliva tests are available for home evaluation of menopause; the most common devices use urine to measure follicle-stimulating hormone. The saliva tests measure estradiol, progesterone, and testosterone. Devices for home screening for colon cancer use either the guaiac test or the fecal immunochemical test. For aid in breast self-examination, patients may use a simulated-breast product designed to train them to detect lumps or a thin, silicone-containing pad intended to increase the sensitivity of the fingers to abnormalities. Urine-dipstick tests can be used to screen for urinary-tract infection, and a swab or panty liner can be used to detect vaginal pH changes indicative of vaginal yeast infection. Home-based tests may be convenient and economical but also have limitations; pharmacists can help educate patients and clinicians. CONCLUSION Many devices are available to help evaluate womens health concerns at home.

Impact of a workplace health and wellness pharmaceutical care service on the weight and obesity classification of employees

Obesity and excess weight gain are public health concerns because they are associated with a number of comorbid conditions that compromise health.1 Obesity is negatively associated with diabetes, dyslipidemia, atherosclerosis, cardiovascular disease, stroke, arthritis, cancer, gallstones, and sleep apnea. According to data from the 1999 National Health and Nutrition Examination Survey,2 61% of American adults are overweight or obese—a 5% increase in prevalence since 1994. In response to this trend, the U.S. Department of Health and Human Services has expanded its 2010 health objectives to include a goal of reducing the prevalence of obesity to less than 15% among U.S. adults over the next decade.1 If this goal is to be achieved, health care professionals must aggressively target excess weight gain and obesity, help their patients learn more about the health risks associated with excess weight, and help patients understand how to prevent and manage obesity. Pharmaceutical care services centered on nutrition and weight loss can be an important component of this strategy. This article focuses on the overweight and obesity management component of the Auburn University Pharmaceutical Care Center’s (AUPCC) Healthy Habits Wellness Program.

Pilot Study to Test the Effectiveness of Different Financial Incentives to Improve Medication Adherence

Background: Medication nonadherence affects health care costs, morbidity, and mortality. Concepts from behavioral economics can guide the development of interventions to improve medication adherence. Objective: To measure the relative effectiveness of 2 behavioral economic-based incentive structures to improve medication adherence. Methods: This randomized controlled trial compared adherence among participants taking antihypertensive or antihyperlipidemic medications randomized to usual care (UC), guaranteed pay-out (GPO) incentives, or lottery incentives. Daily adherence was measured over a 90-day period using electronic caps (Medication Event Monitoring System [MEMS]). The GPO group received

Reimbursement model for pharmacist-directed medication therapy management

30 up-front in a virtual account, with

Improving medication delivery and counseling in community pharmacy.

0.50 deducted for each missed dose. Lottery group participants were eligible for a weekly