Opioid Prescribing Habits in a Family Medicine Residency Program for the Management of Non-Cancer Pain

Objectives: 1. List components of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, 2. Describe the prescribing habits of medical residents and attending physicians within a family medicine residency program, 3. Discuss the direction of future research Methods: A report was generated for all patients with opioids listed as a medication at Christ Health Center family medicine clinic from July 2016 to June 2017. A total of 153 patients were identified with prescriptions written for chronic non-cancer pain indications. Clinical management via a retrospective chart review was completed utilizing a standardized data collection form centered around four of twelve recommendations within the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain: (1) Avoid concurrent opioid and benzodiazepine prescribing; (2) evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy; (3) perform urine drug testing before starting opioids and consider at least annually; and (4) offer/prescribe medication for opioid use disorder for all patients taking chronic opioids. Results: A total of 153 prescriptions were written for chronic indications. The most common indications were chronic back pain (32.0%), unspecified chronic pain (31.4%), and osteoarthritis (9.8%). Average duration of therapy was 26.6 months. Forty-two (27.5%) patients were concurrently receiving benzodiazepine therapy. Eighteen (11.8%) patients performed a drug test before or during therapy. Twenty-two (14.4%) patients had documented discussion with their prescriber evaluating the benefits and harms of their opioid regimens. No patients were prescribed medication for opioid overdose. Conclusion: Prescribing habits did not align with the four-guideline recommendations evaluated. The need for provider-focused education on current pain management practice guidelines was identified.   Article Type: Student Projec

The Role of Clinical Pharmacists in Modifying Cardiovascular Disease Risk Factors

Objective: Assess the effect of intensive clinical and educational interventions aimed at reducing risk factors for Cardiovascular Disease (CVD), implemented by clinical pharmacists, on modifying risk factors in targeted patients at high risk for CVD. Design: Patients with at least two risk factors for CHD were identified at two clinics by conducting a pre-intervention survey and were monitored over a period of 6 months with follow up conversations conducted every 4 weeks by phone and at subsequent physician visits. A post-intervention survey was conducted at the end of the study period to detect modified risk factors. Setting: The Jefferson County Public Health Department (JCHD) Participants: We followed a total of 47 patients over 6 months. The average age at baseline was 51 years old and 80% of the participants were female. The baseline average number of modifiable cardiovascular disease risk factors was 3.7. Measurements: We assessed total number of CVD risk factors, smoking behavior, blood pressure, LDL, A1C, weight, and level of physical activity (major modifiable risk factors by the American Heart Association). Results: Over a 6 month follow-up of 47 patients, statistically significant reductions occurred in total number of CVD risk factors, systolic and diastolic blood pressures, and A1C. Reductions also occurred in LDL level, weight, and changes in smoking behavior and physical activity were identified. Conclusions: Results showed that increased patient counseling on adherence and lifestyle changes along with increased disease state monitoring and medication adjustment led by a clinical pharmacist can decrease risk factors in patients with multiple risk factors for cardiovascular disease.   Type: Student Projec

Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students

Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP) during their Advanced Pharmacy Practice Experience (APPE) in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP’s and used for this purpose with participating students on their ambulatory care APPE. Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18) at the start of their ambulatory care APPE. The test was designed to assess both the students’ baseline knowledge regarding MRP’s, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest) to complete to assess if their knowledge had increased from baseline. Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP’s. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students’ knowledge or ability to properly identify and classify medication related problems (MRP) after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884). However, a statistically significant decline in students’ knowledge occurred on one specific question, which tested their ability to classify MRP’s (p = 0.029). Conclusions: Based on the results of the pre-test, students at our institution enter their APPE year with limited baseline knowledge of medication safety within the ambulatory care setting. Results from the posttest indicate potential ineffectiveness of a written document in providing effective education on MRP’s to students in the experiential setting. Education may be made more effective with a hands-on, active learning approach that overcomes the limitations of other passive forms of learning

Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence

This study assesses the effectiveness of a pharmacy-led transition of care (TOC) service on increasing patients’ understanding of, and reported adherence to, medication post hospital discharge. A cross-sectional survey was administered to patients who were discharged from the hospital with at least one medication received via bedside delivery from the TOC service. Adherence was assessed by asking the patient if they had taken their discharge medications as instructed by the prescriber. Satisfaction with the discharge medication counseling service was assessed through a five-point Likert scale. Descriptive statistics were conducted for all questionnaire items and qualitative data was examined using content analysis. The majority of patients (73%) were counseled on their medication(s) before leaving the hospital. Among those who received counseling, 76 patients had a better understanding of their medication(s). Ninety-five percent of the patients reported adherence, and all six of the patients reporting non-adherence claimed they were not counseled on their medications prior to discharge. Many patients had questions regarding their medication during the follow-up phone call, substantiating the need for further follow-up with patients once they have left the hospital environment. The implementation of medication bedside delivery and counseling services, followed by outpatient adherence monitoring via a transitional care management service, can result in higher levels of reported medication adherence

The Role of Clinical Pharmacists in Modifying Cardiovascular Disease Risk Factors

Objective: Assess the effect of intensive clinical and educational interventions aimed at reducing risk factors for Cardiovascular Disease (CVD), implemented by clinical pharmacists, on modifying risk factors in targeted patients at high risk for CVD. Design: Patients with at least two risk factors for CHD were identified at two clinics by conducting a pre-intervention survey and were monitored over a period of 6 months with follow up conversations conducted every 4 weeks by phone and at subsequent physician visits. A post-intervention survey was conducted at the end of the study period to detect modified risk factors. Setting: The Jefferson County Public Health Department (JCHD) Participants: We followed a total of 47 patients over 6 months. The average age at baseline was 51 years old and 80% of the participants were female. The baseline average number of modifiable cardiovascular disease risk factors was 3.7. Measurements: We assessed total number of CVD risk factors, smoking behavior, blood pressure, LDL, A1C, weight, and level of physical activity (major modifiable risk factors by the American Heart Association). Results: Over a 6 month follow-up of 47 patients, statistically significant reductions occurred in total number of CVD risk factors, systolic and diastolic blood pressures, and A1C. Reductions also occurred in LDL level, weight, and changes in smoking behavior and physical activity were identified. Conclusions: Results showed that increased patient counseling on adherence and lifestyle changes along with increased disease state monitoring and medication adjustment led by a clinical pharmacist can decrease risk factors in patients with multiple risk factors for cardiovascular disease.   Type: Student Projec

The Role of Clinical Pharmacists in Modifying Cardiovascular Disease Risk Factors

Objective: Assess the effect of intensive clinical and educational interventions aimed at reducing risk factors for Cardiovascular Disease (CVD), implemented by clinical pharmacists, on modifying risk factors in targeted patients at high risk for CVD.Design: Patients with at least two risk factors for CHD were identified at two clinics by conducting a pre-intervention survey and were monitored over a period of 6 months with follow up conversations conducted every 4 weeks by phone and at subsequent physician visits. A post-intervention survey was conducted at the end of the study period to detect modified risk factors.Setting: The Jefferson County Public Health Department (JCHD)Participants: We followed a total of 47 patients over 6 months. The average age at baseline was 51 years old and 80% of the participants were female. The baseline average number of modifiable cardiovascular disease risk factors was 3.7.Measurements: We assessed total number of CVD risk factors, smoking behavior, blood pressure, LDL, A1C, weight, and level of physical activity (major modifiable risk factors by the American Heart Association).Results: Over a 6 month follow-up of 47 patients, statistically significant reductions occurred in total number of CVD risk factors, systolic and diastolic blood pressures, and A1C. Reductions also occurred in LDL level, weight, and changes in smoking behavior and physical activity were identified.Conclusions: Results showed that increased patient counseling on adherence and lifestyle changes along with increased disease state monitoring and medication adjustment led by a clinical pharmacist can decrease risk factors in patients with multiple risk factors for cardiovascular disease