Mario M. Zeolla

Development and Validation of an Instrument to Determine Patient Knowledge: The Oral Anticoagulation Knowledge Test

Background: Studies examining the relationship between patient knowledge regarding warfarin therapy and its safe and effective use are limited by the lack of validated knowledge assessment tools. Objective: To develop and validate an instrument to assess patient knowledge regarding oral anticoagulation therapy. Methods: Four nationally recognized anticoagulation experts participated in the instrument development process to ensure content validity. The Oral Anticoagulation Knowledge (OAK) test was administered to subjects on warfarin and a group of age-matched subjects not on warfarin to assess construct validity. A subgroup of warfarin subjects were retested approximately 2–3 months after initial testing to assess test–retest reliability. Internal consistency reliability was assessed by calculating a Kuder-Richardson 20 value. Item analysis was used to assess performance of individual questions. Results: An initial 23 item instrument was pilot tested for readability and comprehension. The OAK test was administered to 74 subjects taking warfarin and 27 age-matched subjects not on warfarin. Thirty-two subjects on warfarin repeated the OAK test an average of 75 days following initial administration. Subjects taking warfarin scored significantly higher than those not on warfarin (72% vs 52%, respectively; p < 0.001), supporting the construct validity of the instrument. Test–retest reliability was acceptable, with a Pearsons correlation coefficient of 0.81. Internal consistency reliability was confirmed by a calculated Kuder–Richardson 20 value of 0.76. Conclusions: The OAK test is a brief, valid, and reliable knowledge assessment instrument that may be a useful tool for research and clinical practice to augment patient education programs.

Privacy in the pharmacy environment: analysis of observations from inside the pharmacy.

OBJECTIVE To measure the extent to which pharmacist-patient conversations are private. DESIGN Cross sectional. SETTING New York State, April to June 2007. PARTICIPANTS No individual participants were enrolled; the study consisted of observations of the pharmacy environment and pharmacy patient-staff interactions. INTERVENTION Measurement of privacy-related distances in the pharmacy. MAIN OUTCOME MEASURES Distance between patients at the pharmacy counter and staff behind the counter, distance between patient waiting area and pharmacy counter, and distance that a pharmacy counter conversation was audible. RESULTS Observational data were recorded from 597 pharmacy staff-patient interactions in 282 pharmacies across New York State. Of the 597 interactions, 167 occurred while a second patient was within 6 ft. Of the 282 pharmacies, pharmacy staff-patient conversations were audible to observers more than 6 ft away in 229 pharmacies; 142 could be heard more than 15 ft away. CONCLUSION Most staff-patient conversations in the pharmacy setting are not private and, as a result, have a high potential for incidental protected health information disclosures.

Alternative approaches to partner notification, diagnosis, and treatment: pharmacists' perspectives on proposed patient delivered partner therapy in New York State, 2007.

Background: Supported by the American Medical Association, patient delivered partner therapy (PDPT) is becoming legal in many states. For some individuals exposed to sexually transmitted infections, the pharmacist may become the sole point of contact with the medical system. Methods: To determine pharmacists’ perceptions about PDPT, education on sexually transmitted infections, and potential barriers that need to be addressed in pharmacies for successful implementation of PDPT, we conducted a survey of pharmacists and observed privacy-related spaces in pharmacies. In 8 counties of the Capital Region, all community pharmacies were invited to participate. In 8 additional counties convenience sampling was utilized. The response proportion was 67.3% overall. Results: Of the 193 pharmacists responding to the survey, 63% supported PDPT for Chlamydia and 78% do not want a behind-the-counter status for Chlamydia antibiotics. The majority (88%) of pharmacists want prescriptions marked as PDPT to alert them to counseling needs. About half the pharmacists reported they would automatically submit PDPT prescriptions to insurance company, a confidentiality issue. The barrier cited most often to patient counseling was time (49%). Conclusions: Pharmacists are open to considering PDPT as part of their professional functions. Although pharmacists need additional sexually transmitted infections education in general, capacity for this training can be developed. Confidentiality issues remain a priority issue to address to protect individuals treated through PDPT.

An evidence-based systematic review of chlorophyll by the Natural Standard Research Collaboration.

ABSTRACT An evidence-based systematic review of chlorophyll by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.