A Clinically Significant Interaction Between Tacrolimus and Multiple Proton Pump Inhibitors in a Kidney Transplant Recipient

The shared metabolism of PPIs and tacrolimus through the CYP enzyme system has been associated with clinically significant drug interactions, especially in patients who are classified as CYP 2C19 PMs. However, existing data are conflicting, indicating that a single mechanism does not account for all interactions. A drug interaction between tacrolimus and omeprazole, esomeprazole, but not lansoprazole, occurred in an 18-yr-old female kidney transplant recipient classified as a CYP 2C19 extensive (normal) metabolizer. This case suggests that further research is needed to establish the definitive mechanism of this potentially serious drug–drug interaction. Physicians prescribing PPIs in organ transplant recipients with tacrolimus immunosuppression should consider close pharmacokinetic monitoring of tacrolimus when starting or switching a PPI

Assessing Patient Adherence and Satisfaction: Clinical Services Beyond the Pharmacy Counter

Medication adherence is a bigger problem than many of us are willing to admit. If patients do not take their medications as prescribed, they will not get the full therapeutic benefits and will put themselves at risk if serious harm. An estimated 125,000 deaths occur in the United States annually due to non-adherence. The objective of this study is to establish a pharmacy intervention model that best provides patient satisfaction and improved medication adherence through the use of home visits and follow-up calls by pharmacists and pharmacy interns at Clark’s Pharmacy. In order to do this, patients receiving home visits from pharmacists or pharmacy interns will receive phone calls 90 days after every visit. These will be patients that have recently been discharged from skilled nursing facilities and other health care centers. In the calls, survey questions will be asked in order to measure their adherence and satisfaction with the pharmacy. Satisfaction will be measured in addition to adherence because studies show that there is a positive correlation between it and adherence. The questions will be formulated in consultation with a pharmacist who has used a similar survey over the phone before. We will need to use convenience sampling, since only patients of Clark’s Pharmacy already being visited at home will qualify to participate. This will be a cross-sectional study. Once data has been collected, SPSS will be used to run descriptive statistics, as well as a Chi-squared test. Data collection will take place from the spring of 2015 until the fall of 2016

Patients’ Perceptions of Pharmacist Intervention Through Pre-Screened Medication Therapy Management Service

Background: The continued challenge of time commitment in a community pharmacy setting is reported by pharmacists as the single largest setback in providing quality patient care. Additionally, when efforts are made by pharmacists to intervene on a patient’s therapy through medication therapy management (MTM), patient “no shows” further challenge an already busy community pharmacy world. Many studies show the value of a pharmacist-patient relationship. However, continued barriers prevent the value of this relationship to take full effect. While numerous methods of comprehensive medication review take place, the issue of establishing a model that best suits the needs of community pharmacy patients still exists. Statement of the Problem: To assess patients’ perceptions of pharmacist intervention through a pre-screened medication therapy management service at prescription pick-up. Description of Methodology: This study utilized a nonprobability convenience sampling of MTM participants at a local community pharmacy pickup for research. A questionnaire was designed to assess patients’ perceptions prior to and after the pharmacist intervention. All adult patients willing to participate in MTM services were included. After the MTM intervention, participants were encouraged to complete the questionnaire at home and mail it back to the pharmacy. The questionnaires were then collected from the pharmacy for review and data was analyzed with SPSS software. Results: Reported increased patient satisfaction and knowledge by survey following the MTM intervention. Unfortunately, the results were insignificant and the study did not achieve ideal power. Conclusions: The descriptive statistical results enumerated in this study do not reveal any applicable trends relating to the use of MTM services at-large. Despite these findings, however, all patients who commented on the intervention provided positive feedback. Further research is encouraged to appropriately assess the value of pharmacist-delivered MTM at prescription pick-up

The Role of Pharmacists in Primary Care Settings

Introduction: The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management Services (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. Various studies have shown that pharmacists conducting MTM improve patient outcomes in some clinical settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and a lack of primary care physicians have become overwhelming, potentially leading to negative patient outcomes. Gaps in communication between hospital, primary care clinics and community pharmacies also contribute to negative patient outcomes. Pharmacists can help bridge the gap in miscommunication and help improve patient outcomes by working in primary care settings. Objective: To determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. Methods: The study is an observational, exploratory study. All Federally Qualified Health Centers (FQHCs) in Ohio will be invited to participate. FQHCs are identified from the HRSA Office of Pharmacy Affairs as Consolidated Health Center Programs. IRB approval will be acquired. A Qualtrics survey will be administered via email to the participants which will include a consent form, information about the study and a link to the survey. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Results: Upon approval from the IRB, data will be collected from summer 2014 to summer 2015. Submitted surveys will be analyzed with the appropriate statistical tests in SPSS. Data will be presented in spring of 2016

Medication Reconciliation of Medically-Complex Emergency Department Patients by Second-Year Professional Pharmacy Students

Background: There is a high potential for medication discrepancies to occur during patient care transitions. However, health professionals must find ways to reduce these and improve patient care, such as with medication reconciliation. This intervention is used to identify a patient’s most accurate medication list by comparing the medical record to another list obtained from the patient, hospital, or other provider. Pharmacists have a major role in this process because of their medicinal expertise, but paying them is expensive, so using students may be more cost-effective. Research has examined fourth-year professional pharmacy students (P4s) performing medication reconciliation during their advanced pharmacy practice experiences; however, no research currently exists that explores the use of P2 students to determine their efficacy. Objectives: The primary objective of this study is to determine the effect of P2 students on medication reconciliation for high-risk patients undergoing care transitions within the emergency department compared to the efforts of P4s as described in the literature. The secondary objective is to determine the impact on 30-day readmission rates. Methodology: This is a historical-controlled, prospective, observational study. Data collection will occur August 2015 through April 2016 at Miami Valley Hospital in Dayton, Ohio. A sample size of at least 34 subjects is required to obtain statistical significance. Subjects will be selected by purposive sampling based on inclusion and exclusion criteria. P2 students will perform medication reconciliation and complete a reporting form providing information on medication discrepancies, interventions, and re-admission dates. Analysis: Researchers will use descriptive statistics, such as mean, mode, and standard deviation, to report each set of data based on normality. One-sample t-tests will also be used to compare P2 data with pre-existing P4 data found in the literature

The Pivotal Role of the Pharmacist in a Primary Care Office

Abstract The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. In various studies, pharmacists conducting MTM have shown improved patient outcomes in community pharmacy and hospital settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and consequences have become overwhelming, leading to negative patient outcomes. A lack of primary care physicians (PCPs) may contribute to these distressing facts. Gaps in communication between hospital, PCPs and community pharmacies also contribute to negative patient outcomes. Pharmacists can bridge the gap in miscommunication and help improve patient outcomes. Thus far in practice, pharmacists have had a limited role in primary care settings. The objective of this study is to determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. For this observational, exploratory research, the primary care settings under study will be all Federally Qualified Health Centers (FQHCs) in Ohio. IRB approval will be acquired before contact is made with participants. The contact person from each FQHC has been identified from the HRSA Office of Pharmacy Affairs. A script will be used to gather email addresses for the manager, physician, nurse and pharmacist, if available, from the contact person. A Qualtrics survey will be administered to these participants via email. The purpose of this study is to establish components of patient care in a primary care office, specifically FQHCs, that other medical professionals identify as lacking, which pharmacists can provide. A consent form, information about the study and a link to the survey will be provided in an email. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Submitted answers will be analyzed with the appropriate statistical tests

Don't Leave Without Them: Dispensing asthma medications to pediatric patients upon discharge is associated with decreased hospital readmissions

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution's outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test. Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; x2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; x2 = 929.04, p < 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; x2 = 52.5; p < 0.001). Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.   Type: Original Researc

Community Education on MTM Services

Abstract Background Medication nonadherence, defined as “the number of doses not taken or taken incorrectly that jeopardizes the patient’s therapeutic outcome,” is a major health problem with about 43% of the general population nonadherent to their medications. Medication nonadherence accounts for an estimated 125,000 deaths per year in the US, 33-69% of medication-related hospital readmissions, and an estimated $100 to$300 billion in direct and indirect medical costs. Medication therapy management (MTM), defined as “a distinct service or group of services that optimize therapeutic outcomes for individual patients,” has been found to reduce medication nonadherence. However, many individuals eligible for MTM services are not aware of the resource available to them and do not believe the service will be beneficial to them. Objectives A pre-post observational study design will be used to determine the effects of two types of educational interventions on MTM of patient’s perceptions of MTM and enrollment in MTM services. Methodology Participants will be divided into two intervention groups. All participants will complete a pre survey to assess current perceptions of MTM services. One group will attend a community educational event on MTM, and the second group will receive an educational brochure in the mail. All participants will complete a post survey to reassess perceptions of MTM after the educational intervention. In addition, all participants will be tracked to determine future enrollment in an MTM service. Analysis Descriptive tests and paired t-tests/Wilcoxon Signed Rank tests will be run on data acquired from pre and post surveys. Unpaired t-tests/Mann Whitney and chi-square tests will be run to compare data between intervention groups. Descriptive tests will be run on data acquired from tracking enrollment

Community Education on MTM Services

Background: Medication nonadherence, defined as “the number of doses not taken or taken incorrectly that jeopardizes the patient’s therapeutic outcome,” is a major health problem with about 43% of the general population nonadherent to their medications. Medication nonadherence accounts for an estimated 125,000 deaths per year in the US, 33-69% of medication-related hospital readmissions, and an estimated $100 to$300 billion in direct and indirect medical costs. Medication therapy management (MTM), defined as “a distinct service or group of services that optimize therapeutic outcomes for individual patients,” has been found to reduce medication nonadherence. However, many individuals eligible for MTM services are not aware of the resource available to them and do not believe the service will be beneficial to them. Objectives: A pre post observational study design will be used to determine the effects of two types of educational interventions on MTM of patient’s perceptions of MTM and enrollment in MTM services. Methodology: Participants will be divided into two intervention groups. All participants will complete a pre survey to assess current perceptions of MTM services. One group will attend a community educational event on MTM, and the second group will receive an educational brochure in the mail. All participants will complete a post survey to reassess perceptions of MTM after the educational intervention. In addition, all participants will be tracked to determine future enrollment in an MTM service. Analysis: Descriptive tests and paired t-tests/Wilcoxon Signed Rank tests will be run on data acquired from pre and post surveys. Unpaired t-tests/Mann Whitney and chi-square tests will be run to compare data between intervention groups. Descriptive tests will be run on data acquired from tracking enrollment