Sarah M. Westberg

Pharmacy-Related Health Disparities Experienced by Non–English-Speaking Patients: Impact of Pharmaceutical Care

OBJECTIVES To identify the availability of foreign language services in pharmacies near a medical clinic serving a large immigrant population and determine whether the type of observed drug therapy problems differed between English- and non-English-speaking patients at this clinic. SETTING A community health care center in a diverse neighborhood of Minneapolis, Minnesota. PARTICIPANTS 40 pharmacies near the clinic and in the surrounding Minneapolis-St. Paul area known to provide services to patients in languages in addition to English and 91 clinic patients, including 38 for whom English was not their primary language, seen for full pharmaceutical care assessments. INTERVENTIONS Comprehensive drug therapy assessments were conducted for English- and non-English-speaking patients (with assistance from interpreters) in a primary care setting secondary to physician referral. Patient-specific data and the results of the pharmacists assessment were recorded in a patient management database. MAIN OUTCOME MEASURES Language services provided by area pharmacies, frequency of drug therapy problems in English- and non-English-speaking patients, and the status of patients medication conditions before and after provision of pharmaceutical care. RESULTS Of the six primary languages other than English (Vietnamese, Hmong, Laotian, Somali, Spanish, and Cambodian) spoken by clinic patients, written or verbal information was available for five languages in one or more area pharmacies. The clinic pharmacist completed comprehensive assessments for 91 patients via 230 patient encounters, identifying 186 drug therapy problems. Problems related to adherence were significantly more prevalent in non-English-speaking patients compared with English-speaking patients (31% versus 12%). In all 91 patients, the percentage achieving desired drug therapy outcomes improved by 24% after a pharmacist joined the team of clinic providers. CONCLUSION Despite the availability of clinic-based interpreters and foreign language services in pharmacies, adherence-related problems are significantly more common in non-English-speaking patients. Pharmacists committed to providing pharmaceutical care must consider the impact of language barriers when working to optimize drug therapy outcomes.

An interprofessional diabetes experience to improve pharmacy and nursing students' competency in collaborative practice.

Objective. To improve pharmacy and nursing students’ competency in collaborative practice by having them participate in an interprofessional diabetes experience involving social networking. Design. An existing elective course on diabetes management was modified to include interprofessional content based on Interprofessional Education Collaborative (IPEC) competency domains. Web-based collaborative tools (social networking and video chat) were used to allow nursing and pharmacy students located on 2 different campuses to apply diabetes management content as an interprofessional team. Assessment. Mixed-method analyses demonstrated an increase in students’ knowledge of the roles and responsibilities of the other profession and developed an understanding of interprofessional communication strategies and their central role in effective teamwork. Conclusion. Interprofessional content and activities can be effectively integrated into an existing course and offered successfully to students from other professional programs and on remote campuses.

Outcomes of medication therapy review in a family medicine clinic

OBJECTIVE To evaluate the effects of pharmacist-conducted medication therapy review (MTR) and intervention on the quality of care of patients in a family medicine clinic. DESIGN Prospective, observational, cohort study. SETTING Family medicine clinic in Minnesota during 2000-2001. PATIENTS Patients were enrolled in a statewide nonprofit managed care organization; selected patients were seen by a clinical pharmacist. INTERVENTION Following MTR, medication-related problems (MRPs) were identified and resolved. MAIN OUTCOME MEASURES MRPs identified and resolved, improvement in clinical status, achievement of therapeutic goals, important medication use, and reduction in number of medications. RESULTS 92 patients were included in the study, with a total of 203 patient encounters. MRPs were identified in 90% of patients, with a total of 250 identified. Overall status of medical conditions improved in 45% of patients, 46% stayed the same, and 9% declined (P < 0.001). Significant improvement in status was found for hypertension (P = 0.007), dyslipidemia (P = 0.002), and asthma (P = 0.011). Significant improvement was seen for aspirin use for myocardial infarction prevention (50% vs. 93%, P = 0.031) and inhaled steroids for asthma (36% vs. 64%, P = 0.031). The number of medications was reduced from an average of 3.92 to 3.04 (P < 0.001) per patient. CONCLUSION MTR and intervention by a pharmacist positively affected quality of care in this family medicine clinic.

The limitation of good intentions: Prescribing medications for the uninsured

Identifying affordable drug therapy options for individuals who lack prescription drug insurance is a problem frequently encountered by prescribers. Medication samples and manufacturer-sponsored assistance programs represent sources often used to address affordability issues. However, these sources have the potential to introduce health disparities through various mechanisms, including reduced access to the drug of choice, consistencies with access, and drug regimen complexities that adversely affect adherence. Prescribers should consider all sources of affordable medications and openly discuss treatment options and the anticipated outcomes of each with patients to ensure the prescribing of agents that optimize outcomes while balancing patient affordability.

Use of Compounded Bioidentical Hormone Therapy in Menopausal Women: An Opinion Statement of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy

Menopausal symptoms affect a significant portion of women. Traditional treatment with manufactured hormone therapy can alleviate these symptoms, but many women and their health care providers are concerned about the risks, such as venous thromboembolism and certain types of cancer, demonstrated with manufactured hormone therapy. Compounded bioidentical hormone therapy has been proposed and is often used as a solution for these concerns. Despite this use, no data are currently available to support the claims that compounded bioidentical hormone therapy is a safer or more efficacious option compared with manufactured hormone therapy. A common misperception is that all manufactured products consist of synthetic hormones and all compounded medications consist of natural hormones; however, in fact, significant overlap exists. Several key stakeholder organizations have issued statements expressing concern about the lack of evidence regarding the efficacy and safety of compounded bioidentical hormone therapy, in addition to concerns regarding prescribing patterns. The Womens Health Practice and Research Network of the American College of Clinical Pharmacy recommends against the consistent use of compounded bioidentical hormones as a safer option compared with manufactured therapy and supports the statements of other key organizations, acknowledging the need for more robust clinical studies to evaluate the potential advantages and disadvantages of compounded bioidentical products compared with manufactured products.

Complementary and Alternative Medicine in U.S. Adults with Diabetes: Reasons for Use and Perceived Benefits.

Although complementary and alternative medicine (CAM) is increasingly used, little is known about the reasons for CAM use (treatment, wellness, or both), or the self‐reported perceived benefits among US adults with diabetes. In this study we estimated prevalence rates of overall and specific types of CAM, as well as the perceived benefits of CAM, by reason for use among US diabetic adults.

Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences

Objective. To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Design. Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students’ competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Assessment. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Conclusions. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs.

Drug Therapy Problems Identified by Pharmacists Through Comprehensive Medication Management Following Hospital Discharge

Background: Pharmacists influence health care outcomes through the identification and resolution of drug therapy problems (DTPs). Objective: The objectives of this study were to describe number, type, and severity of DTPs based on clinical significance and likelihood of harm in patients transitioning from hospital to home as assessed during a comprehensive medication management (CMM) visit with a pharmacist. Secondary objectives were to assess intrarater reliability in severity ratings and assess likelihood of harm for adverse drug reactions (ADR) by drug classes. Methods: Retrospective review of 408 patients having a face-to-face, telephonic, or virtual CMM visit within the Fairview Health System. Teams of 3 investigators reviewed each DTP from the electronic medical record for each of the 408 patients and assigned a severity score (0-10) for clinical significance and likelihood of harm. Main Results: The highest severity DTP classes were adherence and ADR. The lowest severity DTP class was unnecessary drug therapy. An average of 2.5 DTPs was found per patient at the index CMM visit following hospital discharge. The most common DTP classes were needs additional therapy and dose too low. There were statistically significant differences in DTP severity scoring between reviewer types, though differences were <5%. Drug classes with the highest severity ADR included diabetes, cardiovascular, and anticoagulant/antiplatelet agents. Conclusions: The DTP severity ratings indicated that reviewers found ADR and adherence DTPs were potentially the most severe. There were differences in DTP ratings between reviewer types, though clinical significance of these differences is unclear.

Guide for Drug Selection During Pregnancy and Lactation: What Pharmacists Need to Know for Current Practice:

Objective: To provide guidance for clinicians on risk assessment of medication use during pregnancy and lactation. Data Sources: Authors completed PubMed searches to identify articles focused on the use of medications in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. Study Selection and Data Extraction: Articles were reviewed to provide overall guidance to medication selection during pregnancy. The following information was reviewed: medication use in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. Data Synthesis: This article will provide an overview of medication safety considerations during pregnancy and lactation. Information was interpreted to help clinicians predict the potential risk and benefit in each patient to make an evidence-based decision. The article concludes with guidance on risk assessment and how pharmacists may support fellow health care providers and their patients when considering medication use. Conclusions: Information about the effects of medication use during reproductive periods is limited. With the removal of the Food and Drug Administration pregnancy categories, clinicians will be relying on pharmacists to aid in the appropriate selection of therapies for patients. It is critical that pharmacists keep abreast of resources available and be able to assess data to help prescribers and their patients.

Use of Complementary and Alternative Medicine in Older Adults With Diabetes

Older adults with diabetes are at high risk for having multiple chronic conditions and diabetes complications and often take multiple medications concomitantly. Studies have shown that many Americans are using complementary and alternative medicine (CAM) to either improve or manage their health (1,2). Individuals have diverse purposes for using CAM, from treating specific conditions, such as back and neck pain (e.g., acupuncture and chiropractic), to improving general health and wellness (e.g., meditation and tai chi). Since relatively little is known about the prevalence and patterns of CAM use in older adults with diabetes, we investigated this topic to guide integrated, patient-centered health care use for this population. We used data from the 2012 National Health Interview Survey (NHIS), which is an annual cross-sectional in-person interview survey demonstrating health care trends among noninstitutionalized civilians in the U.S. (3). The NHIS collects comprehensive CAM-related information every 5 years. The sample included adults aged 65 or older who reported having …