Stefanie P. Ferreri

Health benefits of dietary fiber

Dietary fiber intake provides many health benefits. However, average fiber intakes for US children and adults are less than half of the recommended levels. Individuals with high intakes of dietary fiber appear to be at significantly lower risk for developing coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal diseases. Increasing fiber intake lowers blood pressure and serum cholesterol levels. Increased intake of soluble fiber improves glycemia and insulin sensitivity in non-diabetic and diabetic individuals. Fiber supplementation in obese individuals significantly enhances weight loss. Increased fiber intake benefits a number of gastrointestinal disorders including the following: gastroesophageal reflux disease, duodenal ulcer, diverticulitis, constipation, and hemorrhoids. Prebiotic fibers appear to enhance immune function. Dietary fiber intake provides similar benefits for children as for adults. The recommended dietary fiber intakes for children and adults are 14 g/1000 kcal. More effective communication and consumer education is required to enhance fiber consumption from foods or supplements.

Redesign of a Large Lecture Course into a Small-Group Learning Course

Objective. To describe the redesign of a large self-care course previously delivered in a traditional lecture format to a small-group case-based course. Design. Prereadings and study guides were used to facilitate students’ independent learning prior to class. Large lecture classes were replaced with smaller group-based learning classes. This change in delivery format allowed students to spend the majority of class time conducting small-group learning activities, such as case studies to promote communication, problem solving, and interpersonal skills. Assessment. Changes in course delivery were assessed over a 2-year period by comparing students’ grades and satisfaction ratings on course evaluations. A comparison of course evaluations between the class formats revealed that students were provided more opportunities to develop verbal communication skills and tackle and resolve unfamiliar problems in the revised course. The activities resulted in better overall course grades. Conclusions. Redesigning to a small-group discussion format for a self-care course can be accomplished by increasing student accountability for acquiring factual content outside the classroom. Compared with student experiences in the previous large lecture-based class, students in the smaller-class format reported a preference for working in teams and achieved significantly better academic grades with the new course format.

Impact of Community Pharmacy Automation on Workflow, Workload, and Patient Interaction

OBJECTIVE To compare workload productivity, workflow efficiency, and pharmacist-patient interaction in automated and nonautomated community pharmacies. DESIGN Observational study. SETTING Four community pharmacy sites within a regional pharmacy chain. STUDY PARTICIPANTS 173 patients and 11 pharmacists. INTERVENTIONS Patient surveys, pharmacist surveys, and direct observation. MAIN OUTCOME MEASURES Patient satisfaction, frequency of pharmacist-patient interactions, and prescription dispensing productivity and efficiency. RESULTS Results from the three nonautomated pharmacies were averaged and compared with results from the automated pharmacy. Patient satisfaction was generally favorable for both automated and nonautomated pharmacies, but scores for the automated site were significantly better on items measuring one domain, technical competence of pharmacy staff. No association was found between patient counseling and prescription workload in automated or nonautomated sites. Personnel at the automated site made significantly more offers to counsel patients, but the number of patients who received counseling did not differ significantly. Automation was associated with a higher number of prescriptions dispensed per full-time equivalent pharmacist and fewer technical dispensing tasks performed by pharmacists. CONCLUSION Patient satisfaction was not related to the presence of an automated dispensing system. Automation was associated with higher prescription productivity, but actual counseling rates were no different from those observed in nonautomated pharmacies. The likelihood that a patient would receive counseling was not related to staffing levels, automation, or workload. Whether counseling occurred appeared to depend on factors other than automation.

Implementation of a pharmacogenomics service in a community pharmacy

OBJECTIVE To determine the feasibility of implementing a pharmacogenomics service in a community pharmacy. SETTING A single community pharmacy that is part of a regional chain known for offering innovative pharmacy services. PRACTICE DESCRIPTION Community pharmacists at the project site routinely provide clinical pharmacy services, including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. PRACTICE INNOVATION The implementation of a pharmacogenomic testing and interpretation service for the liver isoenzyme cytochrome P450 2C19. PARTICIPANTS 18 patients taking clopidogrel, a drug metabolized by CYP2C19. MAIN OUTCOME MEASURES Rate of patient participation, rate of prescriber acceptance of pharmacist recommendation, time to perform genetic testing service, and number of claims submitted to and paid by insurance. RESULTS Of 41 patients taking clopidogrel and meeting project criteria, 18 (43.9%) enrolled and completed testing and interpretation of pharmacogenomic results. The mean time pharmacists spent completing all stages of the project with each participant was 76.6 minutes. The mean time to complete participation in the project (time between persons first and second visit) was 30.1 days. Nine patients had wild-type alleles, and pharmacists recommended continuation of therapy as ordered. Genetic variants were found in the other nine patients, and all pharmacist recommendations for modifications in therapy were ultimately accepted by prescribers. Overall, 17 patients consented to filing of reimbursement claims with their insurers. Five were not able to be billed due to submission difficulties. Of the remaining 12, none was paid. CONCLUSION A pharmacogenomics service can be an extension of medication therapy management services in a community pharmacy. Prescribers are receptive to having community pharmacists conduct pharmacogenomics testing, but reimbursement is a challenge.

Pharmacist-administered subcutaneous depot medroxyprogesterone acetate: a pilot randomized controlled trial

BACKGROUND The objectives of this study were to assess the feasibility of administering subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in a pharmacy setting and assess patient satisfaction. STUDY DESIGN Fifty women, at least 18 years of age, presenting to a family planning clinic to initiate, continue or restart any form of DMPA were randomized to receive two subsequent injections at a nearby pharmacy by trained pharmacists or at the clinic. Women completed two follow-up surveys to rate their satisfaction with DMPA-SC and their clinic/pharmacy experiences. RESULTS The relative risk of returning and receiving a second DMPA-SC injection of women randomized to the pharmacy compared with those randomized to the clinic was 0.73 (95% CI 0.42-1.27). The relative risk of returning and receiving a third DMPA-SC injection was 0.75 (95% CI 0.39-1.46). Most women found the pharmacy setting convenient (70%), private (100%), the providers respectful (100%) and were satisfied with DMPA-SC and the pharmacy as a clinical site (> or = 89%). No significant difference in patient satisfaction with location, convenience, privacy, and respect from providers was found between study groups (p>.05), nor were there significant differences in attitudes or satisfaction among women between their two follow-up injections. CONCLUSION Administration of DMPA-SC by pharmacists in a pharmacy setting is feasible. Continuation rates and patient satisfaction with DMPA-SC and the pharmacy setting were comparable to those who received DMPA-SC in a family planning clinic.

Exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy

AIM To describe the exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy. An institutional review board-approved protocol for a clopidogrel pharmacogenetic program in a community pharmacy was developed to address feasibility and evaluate the pilot program. STUDY CONCEPT Subjects taking clopidogrel are asked to participate at the point of medication dispensing. A pharmacist schedules an appointment with subjects to discuss the study and collects a buccal swab sample for CYP2C19 testing. When the results are available, the pharmacist consults with the subjects prescriber regarding test result interpretation and associated recommendations, and schedules a second appointment with the participant to discuss results and review any physician-approved therapeutic changes. The intervention-associated consultation is then billed to the subjects insurance. RESULTS Subject enrollment has begun. CONCLUSION Community pharmacists may be valuable partners in pharmacogenetics.

Making pharmacogenetic testing a reality in a community pharmacy

OBJECTIVE To provide information for community pharmacies considering implementation of a pharmacogenetic testing service. SETTING A single community pharmacy from a regional chain. PRACTICE DESCRIPTION Community pharmacists at the study site routinely provide pharmacy services including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. The pharmacy is a training site for post-graduate year 1 and 2 community-pharmacy residents and for introductory and advanced pharmacy practice experience students. PRACTICE INNOVATION Implementation of a pharmacogenetics testing service in a community pharmacy. MAIN OUTCOME MEASURES Feasibility of offering a pharmacogenetics testing service in a community pharmacy. RESULTS Study investigators identified several internal and external barriers to the community pharmacy when initiating a pharmacogenetics service. This article shares experiences of the study team and solutions to the identified barriers. CONCLUSION Community pharmacies interested in providing pharmacogenetic testing can overcome barriers by identifying practice partners and planning appropriately.

Pharmacogenomics in a community pharmacy: ACT now

OBJECTIVE To highlight the opportunity for community pharmacists to provide pharmacogenomic testing and counseling. DATA SOURCES Peer-reviewed pharmacy literature. SUMMARY Pharmacists practicing in community pharmacy are accustomed to optimizing drug therapy through various medication therapy management programs. They use patient-specific information obtained from the patient and their prescribers to cater patient-specific drug regimens. Pharmacogenomics is rapidly evolving, and this field can help optimize medication therapy using an individuals genetic code to identify opportunities for increased or decreased adverse effects or changes in efficacy. Pharmacogenomic testing technology has made conducting pharmacogenomic testing in community pharmacies possible. Pharmacists must arm themselves with the knowledge and skills specific to pharmacogenomics in order to fully integrate this expanding area into patient care and turn this into a great opportunity. CONCLUSION Advances in knowledge and technology regarding pharmacogenomics coupled with the overwhelming access and use of a community pharmacist by patients provides a tremendous opportunity for community pharmacists to lay claim to the field of pharmacogenomics. Pharmacists are able and needed to provide testing, evaluate results, and offer patient and prescriber education for pharmacogenomics. Pharmacists must take steps to assess the entire clinical picture and use pharmacogenomics where appropriate to optimize drug therapy.

Assessment of Workflow Redesign in Community Pharmacy

OBJECTIVE To assess the effect that workflow enhancements have on dispensing responsibilities and pharmacist-patient interaction in the community pharmacy setting. DESIGN Pre-post comparison. Pre-assessment data were obtained from a multisite observational study. SETTING Pharmacy within a regional pharmacy chain. STUDY PARTICIPANTS 3 pharmacists and 110 patients. INTERVENTION The pharmacy was physically remodeled to enable workflow changes, including defining dispensing responsibilities with an emphasis on patient counseling, providing an additional 6 feet of counter space, upgrading technology, installing a third computer, implementing tools to augment the filling process, and requesting that cashiers rephrase the offer to counsel to encourage patient acceptance. Patients and pharmacists were surveyed about the experiences and beliefs, and pharmacy activities were observed directly. MAIN OUTCOME MEASURES Patient counseling and prescription dispensing. activities. RESULTS The number of pharmacists who perceived that they had adequate time to counsel patients increased as a result of the intervention (0 of 3 responding pharmacists before the intervention, compared with 2 of 2 afterward). Patient satisfaction scores both before and after the intervention were predominantly favorable and did not differ significantly. The most relevant change in dispensing activities was pharmacist involvement with data entry into the computer, which decreased from 61% to 10%. Oral counseling offers to patients increased significantly, from 5% to 85%, but counseling rates remained low throughout the study and were not measurably affected by workload. CONCLUSION Workflow redesign has positively affected the dispensing activities at the study site. Technicians took more responsibility for dispensing tasks. Given the drastic increase in counseling offers but lack of effect on counseling rates, patient behavior and expectations with regard to counseling likely need to change to further improve dynamics in the community pharmacy.

Retrospective analysis of estimated cost avoidance following pharmacist-provided medication therapy management services.

Objective: To compare the estimated cost avoidance (ECA) of pharmacist-provided medication therapy management (MTM) services among common disease states encountered in community pharmacy practice. Design: Retrospective analysis. Setting: Nine community pharmacies in North Carolina. Patients: Three hundred and sixty-four patients who are 65 years of age or older, a Medicare Part D beneficiary and a North Carolina resident. Interventions: An MTM pharmacist-provider conducted medication reviews to eligible patients between July 2009 and October 2009. For each encounter, patient interventions, pharmacist recommendations, and ECA were recorded. Main outcome measure: ECA. Results: In 9 pharmacy locations, 634 MTM interventions were documented during the study period. The ECA in a 4-month period yielded approximately