Identifying Medication Management Smartphone App Features Suitable for Young Adults With Developmental Disabilities: Delphi Consensus Study

Background: Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained. Objective: The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus method. Methods: A compilation of medication management app features was performed by searching the iTunes App Store, United States, in February 2016, using the following terms: adherence, medication, medication management, medication list, and medication reminder. After identifying features within the retrieved apps, a final list of 42 features grouped into 4 modules (medication list, medication reminder, medication administration record, and additional features) was included in a questionnaire for expert consensus rating. A total of 52 experts in developmental disabilities, including persons with developmental disabilities, caregivers, and professionals, were invited to participate in a 3-round Delphi technique. The purpose was to obtain consensus on features that are preferred and suitable to promote independence in the medication management process among persons with developmental disabilities. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Results: A total of 75 responses were received over the 3 Delphi rounds—30 in the first round, 24 in the second round, and 21 in the third round. At the end of the third round, cumulative consensus was achieved for 60% (12/20) items in the medication list module, 100% (3/3) in the medication reminder module, 67% (2/3) in the medication administration record module, and 63% (10/16) in the additional features module. In addition to the medication list, medication reminder, and medication administration record features, experts selected the following top 3 most important additional features: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders. Conclusions: Although several mobile apps for medication management exist, few are specifically designed to support persons with developmental disabilities in the complex medication management process. Of the 42 different features assessed, 64% (27/42) achieved consensus for inclusion in a future medication management app. This study provides information on the features of a medication management app that are most important to persons with developmental disabilities, caregivers, and professionals

The Nia Project: Baseline report

The onset of puberty and menarche is a particularly vulnerable time for girls, when external pressures are exacerbated by their lack of knowledge of their bodies, their rights, and the implications of their decisions, and by their inability to manage puberty and adolescence safely and comfortably with appropriate menstrual health and hygiene management (MHM) products. Although several programs have previously been developed to address girls’ MHM needs globally, few have been evaluated, and where evidence does exist the results have been mixed. In collaboration with ZanaAfrica, the Population Council is evaluating the Nia Project, a set of interventions for adolescent girls in Kilifi County, Kenya. This evaluation analyzes the effect of distribution of Nia brand disposable sanitary pads and provision of reproductive health education (i.e., facilitated sessions and the Nia Teen magazine) on girls’ education and reproductive health outcomes. This report presents data from the baseline survey of the Nia Project, providing a multidimensional description of a sample of the girls who will be participating in the Nia Project and the schools they attend

The Nia Project—Brief

This brief provides highlights from the Nia Project conducted in Kenya. The study found that while gaps exist in girls’ capabilities, particularly knowledge and attitudes related to menstruation and reproductive health, the Nia Project has the potential to bridge those gaps. The Project is one of the first randomized controlled trials to explore the role of sanitary pad distribution and reproductive health education—individually and in combination—to improve girls’ educational and sexual and reproductive health outcomes. The findings of this study will make a critical contribution to filling an evidence gap in the field of menstrual health and hygiene management, and in doing so will guide education and health policy in this area in Kenya and in the region

Women’s perceptions of pharmacist‐prescribed hormonal contraception

IntroductionUnintended pregnancy is a public health issue, with young women in their late teens and early 20s at highest risk. Multiple approaches to increasing contraception access have been implemented, including adoption of statewide pharmacist prescribing legislation in multiple states. Indiana does not currently have such legislation in place. The objective of this study was to identify how women at risk for unintended pregnancy in central Indiana perceive pharmacist prescribing of contraception.Study DesignQualitative, one‐on‐one semi‐structured interviews.MethodsPurposive, convenience sampling of eligible women 18 to 29‐years‐old who live in Indiana was used. Recruitment occurred via printed flyers placed in public locations that were not focused on health care, free classified online advertisements, and electronic flyers within Facebook social groups relevant to the study population. Interviews were conducted via telephone until thematic saturation was achieved. Participant demographics, baseline characteristics, current and past barriers to obtaining contraception, and perception of a pharmacist contraception prescribing model were collected. Interview transcripts were coded in an iterative manner with qualitative data analysis software (MAXQDA, Version 12) until consensus was achieved.ResultsFourteen women completed the study. Four primary themes emerged encompassing accessibility, communication, pharmacist attributes, and payment. Thirteen participants would personally utilize a pharmacist prescribing contraceptive service and all stated that this service would be beneficial for other women. Of those women expressing a preference (n = 7), a female pharmacist would be preferred for service delivery. Participants expressed concerns related to access by minors, skills and training of the pharmacist, and environment within the pharmacy.ConclusionsWomen in Indiana desire broader access to contraception. Efforts should be made at the individual pharmacist‐provider level and statewide to explore strategies to increase access. Resources should be allocated to the creation of protocols for pharmacist prescribing within Indiana and other states.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154257/1/jac51169.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154257/2/jac51169_am.pd

A Web Application for Self-Monitoring Improves Symptoms in Chronic Systolic Heart Failure

Objective: The objective of this study was to determine if a Web application that promoted mindfulness of the progress of the chronic disease through self-monitoring improved quality of life in heart failure. Materials and Methods: This was a prospective single-center single-group study. Participants were instructed how to use the Web application and to perform self-monitoring daily for 12 weeks. A comprehensive physical exam, assessment of New York Heart Association (NYHA) class, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and an evaluation of self-management were performed in person at baseline and at 12 weeks. Results: Participants consisted of older (mean, 59 years), predominantly female (63%) adults with NYHA class II or III symptoms. NYHA classification (preintervention versus postintervention, 2.5±0.13 versus 2.0±0.13; p=0.0032) and MLHFQ score (55.7±4.6 versus 42.6±5.1, respectively; p=0.0078) improved over 12 weeks of self-monitoring. A trend toward improvement was also demonstrated in weight (preintervention versus postintervention, 209±9.6 pounds versus 207±9.4 pounds; by paired t test, p=0.389), number of times exercised per week (1.29±0.5 versus 2.5±0.6, respectively; p=0.3), and walk distance (572±147 yards versus 845±187 yards, respectively; p=0.119). Jugular venous distention (preintervention versus postintervention, 8.1±0.6?cm versus 6.7±0.3?cm; p=0.083) and peripheral edema (29.2% versus 16.7%, respectively; p=0.375) decreased after 12 weeks of self-monitoring via the Web application. Conclusions: A Web application for self-monitoring heart failure over 12 weeks improved both NYHA classification and MLHFQ score. The trend in improved physical activity and physical exam support these outcomes. The number of patients reporting a sodium-restricted diet increased over the 12 weeks, which may have led to the positive findings.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140281/1/tmj.2014.0095.pd

Impact of a passive social marketing intervention in community pharmacies on oral contraceptive and condom sales: a quasi-experimental study

Abstract Background Almost 50% of pregnancies in the United States are unwanted or mistimed. Notably, just over one-half of unintended pregnancies occurred when birth control was being used, suggesting inappropriate or poor use or contraceptive failure. About two-thirds of all women who are of reproductive age use contraceptives, and oral hormonal contraceptives remain the most common contraceptive method. Often, contraceptive products are obtained in community pharmacies. The purpose of this study was to determine whether a pharmacy-based intervention would impact sales of contraceptive products in pharmacies. Methods This study was conducted in Iowa and used a quasi-experimental design including 55 community pharmacies (independent and grocery) in 12 counties as the intervention and 32 grocery pharmacies in 10 counties as a comparison group. The passive intervention was focused towards 18–30 year old women who visited community pharmacies and prompted those of childbearing age to “plan your pregnancy” and “consider using birth control”. The intervention was delivered via educational tri-fold brochures, posters and ‘shelf talkers.’ Data sources for evaluation were contraceptive sales from intervention and comparison pharmacies, and a mixed negative binomial regression was used with study group*time interactions to examine the impact of the intervention on oral contraceptive and condom sales. Data from 2009 were considered baseline sales. Results From 2009 to 2011, condom sales decreased over time and oral contraceptives sales showed no change. Overall, the units sold were significantly higher in grocery pharmacies than in independent pharmacies for both contraceptive types. In the negative binomial regression for condoms, there was an overall significant interaction between the study group and time variables (p = 0.003), indicating an effect of the intervention, and there was a significant slowing in the drop of sales at time 3 in comparison with time 1 (p < 0.001). There was a statistically significant association between pharmacy type and study group, where the independent intervention pharmacies had a higher proportion of stores with increases in condom sales compared to grocery pharmacies in the intervention or comparison group. Conclusions A passive community pharmacy-based public health intervention appeared to reduce the decrease in condom sales from baseline, particularly in independent pharmacies, but it did not impact oral contraceptive sales.http://deepblue.lib.umich.edu/bitstream/2027.42/110681/1/12889_2015_Article_1495.pd

Primary healthcare policy and vision for community pharmacy and pharmacists in the united states

© 2020, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved. The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges

Effect of a care transition intervention by pharmacists: an RCT

Abstract Background Pharmacists may improve medication-related outcomes during transitions of care. The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager (PCM) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events, rehospitalization and emergency department visits. Methods Design. Randomized, controlled trial of 945 participants assigned to enhanced, minimal and usual care groups conducted 2007 to 2012. Subjects. Participants with cardiovascular-related conditions and/or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine, family medicine, cardiology or orthopedics. Intervention. The minimal group received admission history, medication reconciliation, patient education, discharge medication list and medication recommendations to inpatient team. The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3–5 days post-discharge. Participants were followed for 90 days post-discharge. Main Outcomes and Measures. Medication appropriateness index (MAI), adverse events, adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression, as models accommodating random effects due to pharmacists indicated little clustering. Results Study groups were similar at baseline and the intervention fidelity was high. There were no statistically significant differences by study group in medication appropriateness, adverse events or adverse drug events at discharge, 30-day and 90-day post-discharge. The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days, and this was true across all study groups. Post-discharge, about 16% of all participants experienced an adverse event, and this did not differ by study group (p > 0.05). Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge, where 15% of all participants had a 30-day readmission. Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group. Conclusion The pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups. Trial registration Clinicaltrials.gov registration: NCT00513903 , August 7, 2007.http://deepblue.lib.umich.edu/bitstream/2027.42/109686/1/12913_2014_Article_3640.pd

Value of Online Medication Therapy Management Resources: Community Pharmacist Perspectives

Objectives: To describe pharmacists’ attitudes toward and satisfaction with on-line training modules on MTM tools and tips for pharmacists and to characterize how useful the tools and concepts in the modules were to pharmacists when delivering MTM services. Methods: Researchers distributed a web-based survey to pharmacists who had viewed the training modules that had been posted onto the training web site of OutcomesMTM. The majority of survey questions consisted of a 6-point Likert scale. Questions assessed pharmacists’ opinions on the use of the tools. Information also was collected on implementing MTM tips, pharmacist demographics, and practice site characteristics. Results: Respondents rated the Tool to Improve Medications in the Elderly via Review (TIMER) and DRug Adherence Work-up (DRAW) tools favorably across multiple items. Many pharmacists integrated the MTM tips into their practices, and reported increased efficiency in their delivery of MTM services. Conclusion: Pharmacist training and tools such as the TIMER and DRAW tools plus MTM practice tips can assist pharmacists in providing MTM services to patients

Intermediate to felsic middle crust in the accreted Talkeetna arc, the Alaska Peninsula and Kodiak Island, Alaska : an analogue for low-velocity middle crust in modern arcs

Author Posting. © American Geophysical Union, 2010. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Tectonics 29 (2010): TC3001, doi:10.1029/2009TC002541.Seismic profiles of several modern arcs have identified thick, low-velocity midcrustal layers (Vp = 6.0–6.5 km/s) that are interpreted to represent intermediate to felsic plutonic crust. The presence of this silicic crust is surprising given the mafic composition of most primitive mantle melts and could have important implications for the chemical evolution and bulk composition of arcs. However, direct studies of the middle crust are limited by the restricted plutonic exposures in modern arcs. The accreted Talkeetna arc, south central Alaska, exposes a faulted crustal section from residual subarc mantle to subaerial volcanic rocks of a Jurassic intraoceanic arc and is an ideal place to study the intrusive middle crust. Previous research on the arc, which has provided insight into a range of arc processes, has principally focused on western exposures of the arc in the Chugach Mountains. We present new U-Pb zircon dates, radiogenic isotope data, and whole-rock geochemical analyses that provide the first high-precision data on large intermediate to felsic plutonic exposures on Kodiak Island and the Alaska Peninsula. A single chemical abrasion–thermal ionization mass spectrometry analysis from the Afognak pluton yielded an age of 212.87 ± 0.19 Ma, indicating that the plutonic exposures on Kodiak Island represent the earliest preserved record of Talkeetna arc magmatism. Nine new dates from the extensive Jurassic batholith on the Alaska Peninsula range from 183.5 to 164.1 Ma and require a northward shift in the Talkeetna arc magmatic axis following initial emplacement of the Kodiak plutons, paralleling the development of arc magmatism in the Chugach and Talkeetna mountains. Radiogenic isotope data from the Alaska Peninsula and the Kodiak archipelago range from $\varepsilon$Nd(t) = 5.2 to 9.0 and 87Sr/86Srint = 0.703515 to 0.703947 and are similar to age-corrected data from modern intraoceanic arcs, suggesting that the evolved Alaska Peninsula plutons formed by extensive differentiation of arc basalts with little or no involvement of preexisting crustal material. The whole-rock geochemical data and calculated seismic velocities suggest that the Alaska Peninsula represents an analogue for the low-velocity middle crust observed in modern arcs. The continuous temporal record and extensive exposure of intermediate to felsic plutonic rocks in the Talkeetna arc indicate that evolved magmas are generated by repetitive or steady state processes and play a fundamental role in the growth and evolution of intraoceanic arcs