Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic. Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation. Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting. Type: Original Researc

Perspectives from the Hmong Population on Type 2 Diabetes

The primary goal of the study was to determine perceptions the Hmong population has about Type 2 diabetes. Specific information to be gathered from the Hmong participants were: reactions after being diagnosed with Type 2 diabetes, knowledge and beliefs about medications, and how pharmacists can help them with their diabetes care. Learning the beliefs of this population related to Type 2 diabetes will help identify methods to improve diabetes care and education for Hmong patients. A focus group was conducted with Hmong participants with Type 2 diabetes to explore their perceptions and experiences with diabetes. There were 9 participants in the focus group which lasted approximately 90 minutes. The major themes were a misunderstanding of diabetes and its treatment, a reluctance to adhere to medications, a reluctance to change cultural diet, and the need for clear education from pharmacists. Participant recommendations for pharmacists were to improve their diabetes care by educating them about the condition, medication, and available treatments.   Type: Original Researc

Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic. Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation. Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting. Type: Original Researc

Over-the-Counter Medication Use, Perceived Safety, and Decision-Making Behaviors in Pregnant Women

The purpose of this study was to determine which over-the-counter (OTC) medications women are using during pregnancy, and to assess patients’ perceived safety of these medications. In addition, the decision-making process utilized by pregnant women when choosing OTC drug therapy was explored, including sources of information and recommendation. The subjects included pregnant women 18 years and older. Subjects were solicited as a convenience sample by providing surveys in two urban women’s clinic waiting rooms. Of the 61 respondents, 96.3% had used an OTC medication, herbal, or vitamin during their current pregnancy. The most common products included prenatal vitamins, acetaminophen, cough drops, antacids, calcium, vitamin D, and DHA. The majority of women surveyed regarded over-the-counter medications, vitamins, and herbals as “safe, but would talk to a healthcare professional before using.” The most utilized sources of drug information during pregnancy were a physician (68.9%), midwife (55.7%), and the Internet (44.3%). There were an equal number of respondents obtaining general OTC information from apharmacist as from their family and friends (26.2%). Almost all subjects had used an over-the-counter medication during their pregnancy and the majority considered OTCs safe after first consulting a healthcare professional. Although a high percentage of subjects have obtained their information and recommendations from healthcare professionals, a very small proportion of subjects had utilized a pharmacist as a resource. Being drug experts and easily accessible members of the healthcare team, pharmacists have a responsibility to aid the obstetric population in the appropriate and safe use of over-the-counter drugs, vitamins, and herbals during pregnancy

Over-the-Counter Medication Use, Perceived Safety, and Decision-Making Behaviors in Pregnant Women

The purpose of this study was to determine which over-the-counter (OTC) medications women are using during pregnancy, and to assess patients' perceived safety of these medications. In addition, the decision-making process utilized by pregnant women when choosing OTC drug therapy was explored, including sources of information and recommendation. The subjects included pregnant women 18 years and older. Subjects were solicited as a convenience sample by providing surveys in two urban women's clinic waiting rooms. Of the 61 respondents, 96.3% had used an OTC medication, herbal, or vitamin during their current pregnancy. The most common products included prenatal vitamins, acetaminophen, cough drops, antacids, calcium, vitamin D, and DHA. The majority of women surveyed regarded over-the-counter medications, vitamins, and herbals as "safe, but would talk to a healthcare professional before using." The most utilized sources of drug information during pregnancy were a physician (68.9%), midwife (55.7%), and the Internet (44.3%). There were an equal number of respondents obtaining general OTC information from a pharmacist as from their family and friends (26.2%). Almost all subjects had used an over-the-counter medication during their pregnancy and the majority considered OTCs safe after first consulting a healthcare professional. Although a high percentage of subjects have obtained their information and recommendations from healthcare professionals, a very small proportion of subjects had utilized a pharmacist as a resource. Being drug experts and easily accessible members of the healthcare team, pharmacists have a responsibility to aid the obstetric population in the appropriate and safe use of over-the-counter drugs, vitamins, and herbals during pregnancy. Type: Student Projec

Over-the-Counter Medication Use, Perceived Safety, and Decision-Making Behaviors in Pregnant Women

The purpose of this study was to determine which over-the-counter (OTC) medications women are using during pregnancy, and to assess patients' perceived safety of these medications. In addition, the decision-making process utilized by pregnant women when choosing OTC drug therapy was explored, including sources of information and recommendation. The subjects included pregnant women 18 years and older. Subjects were solicited as a convenience sample by providing surveys in two urban women's clinic waiting rooms. Of the 61 respondents, 96.3% had used an OTC medication, herbal, or vitamin during their current pregnancy. The most common products included prenatal vitamins, acetaminophen, cough drops, antacids, calcium, vitamin D, and DHA. The majority of women surveyed regarded over-the-counter medications, vitamins, and herbals as "safe, but would talk to a healthcare professional before using." The most utilized sources of drug information during pregnancy were a physician (68.9%), midwife (55.7%), and the Internet (44.3%). There were an equal number of respondents obtaining general OTC information from a pharmacist as from their family and friends (26.2%). Almost all subjects had used an over-the-counter medication during their pregnancy and the majority considered OTCs safe after first consulting a healthcare professional. Although a high percentage of subjects have obtained their information and recommendations from healthcare professionals, a very small proportion of subjects had utilized a pharmacist as a resource. Being drug experts and easily accessible members of the healthcare team, pharmacists have a responsibility to aid the obstetric population in the appropriate and safe use of over-the-counter drugs, vitamins, and herbals during pregnancy. Type: Student Projec

Evaluation of a Consumer-Generated Marketing Plan for Medication Therapy Management Services

The purpose of this project was to utilize a consumer-directed, care model redesign methodology to develop and evaluate a marketing plan for medication therapy management services (MTMS) provided in community pharmacies. This was accomplished through a six-step process: (1) application of "design thinking" for eliciting consumer input on redesigning MTMS and marketing approaches, (2) exploratory research, (3) focus group analysis, (4) marketing plan development, (5) marketing plan implementation, and (6) marketing plan evaluation. The findings showed that the application of "design thinking" and focus group analysis was useful for creating a consumer-directed marketing plan for medication therapy management services (MTMS). Implementation and evaluation of the MTMS Marketing Plan revealed that the most successful pharmacies were those that had established business associate agreements with the medical clinics closest to their site of practice, including access to electronic health records. This "virtual electronic presence" of pharmacists in the medical care system was highly consistent with the consumer demand we uncovered for a visible relationship between pharmacists, physicians and other health care providers.   Type: Original Researc

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo