Assessing the Impact of the Consultant Pharmacist on Pneumococcal Vaccine Administration in a Long-term Care Facility.

Objective To describe the impact of consultant pharmacist recommendations on the frequency of pneumococcal vaccines administered to older people admitted to a long-term care facility (LTCF). Design: Retrospective observational study. Setting: LTCF with skilled and intermediate level care. Participants: Adult patients newly admitted to a LTCF in Southwestern Pennsylvania between December 1, 2016, and November 30, 2017, and between January 1, 2018, and December 31, 2019, were included. Interventions The intervention in the study was a consultant pharmacist-driven immunization screening service that was implemented as part of the admission medication review process in January 2018. To assess the impact of the service, the pneumococcal immunization rates of patients who were candidates for pneumococcal vaccination were compared between two patient cohorts who were defined by exposure to the immunization needs assessment and subsequent recommendations by a consultant pharmacist. Results A total of 468 patient admissions were included, with 68 in Cohort 1 and 400 in Cohort 2. Pneumococcal immunization rate, calculated as number of pneumococcal vaccinations administered over the number of admissions eligible for pneumococcal vaccination, had a statistically significant increase (1.9%-20.2%; P < 0.05). Conclusion The recommendations from a consultant pharmacist as a result of an immunization needs assessment upon admission to a LTCF significantly contributed to an increased rate of pneumococcal immunizations. Further investigation is warranted to evaluate future strategies to reduce vaccination refusals.

Implementing an interprofessional information literacy course: impact on student abilities and attitudes.

OBJECTIVES: The authors investigated the impact of an interprofessional, freshman-level, information literacy course on nursing, pharmacy, and allied health professions students by examining whether students successfully met learning objectives in the course related to interprofessional attitudes, identification of research study types, and ability to relate evidence-based practice questions to their disciplines. METHODS: Student posters (n=20) completed in a team project were evaluated to determine whether students were able to accurately identify the type of evidence, population, intervention, and primary outcome of studies (n=192). Additionally, posters (n=78) were evaluated to assess whether students could identify a relevant foreground question and link it to their disciplines. Students also completed the Readiness for Interprofessional Learning Scale (RIPLS) before (n=413) and after (n=352) the course to determine whether their attitudes toward interprofessional learning changed. RESULTS: Students performed well on learning outcomes in the course, with most teams identifying relevant evidence-based practice questions (83.8%) and effectively connecting questions with their disciplines (65.4%). Students correctly identified the type of evidence, population, intervention, and primary outcome for 70.0%, 81.8%, 76.0%, and 74.0% of cited studies, respectively. Student attitudes after the course did not significantly change. CONCLUSION: Interprofessional information literacy education can generate positive learning experiences for freshman health care professions students to increase their beginning-level understanding of research in the health care professions and to prepare them for participation in future interprofessional courses and health care teams.

Patient-Centered Pharmacy Services: A Descriptive Report.

This paper describes a proactive, patient-centered, interprofessional approach to medication review in a long-term care facility. Clinical pharmacy services were provided to residents in multiple high-risk areas including transition of care; medication reconciliation; monitoring of infectious disease, pain, anticoagulation, psychotropic drugs, and falls; and requested consults for any change in condition. Process outcomes were evaluated, specifically the number of patients reviewed, number and type of recommendations made, and acceptance rate of recommendations by physicians; 1,333 medication regimen reviews were conducted. A total of 274 recommendations were made, and 56 recommendations were excluded as "lost to follow-up" because the recommendation was not acknowledged by the physician. Of the 218 acknowledged recommendations, 157 (72%) were accepted. Collective workload statistics suggest that the service identified and eliminated potential drugrelated problems such as inappropriate medications, drug interactions, and discrepancies during medication reconciliation. The large number of reviews conducted in a short time period show that there is a need for regular pharmacist review.

Impact of the fracture risk assessment on patient and physician behavior in osteoporosis prevention.

OBJECTIVE: To evaluate the impact of a pharmacist-directed osteoporosis screening program utilizing the fracture risk assessment (FRAX) tool on patient and physician behavior. METHODS: Postmenopausal women 45 to 65 years with Achilles T score <-1.0 not receiving bisphosphonate therapy were randomly assigned to a control or intervention group. All participants received a heel ultrasound and pharmacist education on risks of low bone mass. The intervention group received the FRAX and shared their results with their physician. Three months after screening, a telephonic questionnaire was administered to all participants. RESULTS: A total of 749 patients were screened, with 87 meeting the enrollment criteria (43 control and 44 intervention). Physician behavior was not different between the groups with respect to ordering vitamin D levels, prescription medication, or dual-energy x-ray absorptiometry scan. A significant difference in vitamin D supplementation occurred between the 2 groups (P = .024). At follow-up, 72.2% of responding participants increased daily calcium intake and 76.4% started or increased physical activity. CONCLUSION: Physician behavior was not influenced by FRAX results in the intervention group; however, positive patient behavior changes occurred in both groups. Primary prevention efforts conducted through heel ultrasound screening and pharmacist consultation led women to follow-up; however, awareness still needs to be raised of the value of FRAX in osteoporosis prevention.

Cultural competency in health care and its implications for pharmacy part 3A: emphasis on pharmacy education, curriculums, and future directions.

Culture influences patients' beliefs and behaviors toward health and illness. As the U.S. population becomes more diverse, a critical need exists for pharmacy education to incorporate patient-centered culturally sensitive health care knowledge and skills into the curriculum. Nursing was the first profession to incorporate this type of learning and training into its curriculums, followed by medicine. Pharmacy has also made great progress to revise curriculums, but inconsistency exists in depth, breadth, and methods across pharmacy colleges. This article addresses important aspects of pharmacy education such as curriculum development, incorporation of educational innovations and techniques into the teaching of patient-centered culturally sensitive health care across the curriculum from didactic to experiential learning, assessment tools, and global education. A preliminary model curriculum with objectives and examples of teaching methods is proposed. Future directions in pharmacy education, teaching and learning scholarship, postgraduate education, licensure, and continuing education are also presented.

Cultural competency in health care and its implications for pharmacy Part 3B: emphasis on pharmacy education policy, procedures, and climate.

The Institute of Medicine has stated that greater diversity within health care professionals leads to improved patient outcomes. Therefore, greater diversity within academia and student bodies is required to create future diverse health care professionals. Cultural sensitivity is required from recruitment to physical environment for administrators, faculty, staff, and students. University, college, and department recruitment, search committees, hiring practices, and admissions policies and procedures need to be assessed to determine whether they reflect the applicant pool and patient populations in their regions and whether they are culturally sensitive to a wide variety of cultures. The mission, vision, policies, procedures, curriculums, and environments should also be created or reviewed, modified, and/or expanded to ensure that no administrator, faculty member, staff member, or student is discriminated against or disadvantaged because of cultural beliefs or practices. In addition to discussing the interplay between cultural sensitivity and academic policies, procedures, and environments, this article briefly discusses specific cultural issues related to religion, spirituality, race, ethnicity, gender, age, marital status, veterans, physical, mental, and learning disabilities, and sexual orientation diversity.

Adverse effects of analgesics commonly used by older adults with osteoarthritis: focus on non-opioid and opioid analgesics.

BACKGROUND: Osteoarthritis (OA) is the most common cause of disability in older adults, and although analgesic use can be helpful, it can also result in adverse drug events. OBJECTIVE: To review the recent literature to describe potential adverse drug events associated with analgesics commonly used by older adults with OA. METHODS: To identify articles for this review, a systematic search of the English-language literature from January 2001 to June 2012 was conducted using PubMed, MEDLINE, EBSCO, and the Cochrane Database of Systematic Reviews for publications related to the medical management of OA. Search terms used were "analgesics," "acetaminophen," "nonsteroidal anti-inflammatory drugs" (NSAIDs), "opioids," "pharmacokinetics," "pharmacodynamics," and "adverse drug events." The search was restricted to those articles that concerned humans aged ≥65 years. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that examined analgesic use in older adults. RESULTS: There are limited data to suggest that non-frail elders are more likely than their younger counterparts to develop acetaminophen-induced hepatotoxicity. However, decreased hepatic phase II metabolism in frail elders may result in increased risk of hepatotoxicity. It is now well established that older adults are at higher risk of NSAID-induced gastrointestinal toxicity and renal insufficiency. Insofar as opioids, the data that suggest an increased risk of falls, fractures, or delirium need to be tempered by the potential risk of inadequately treating severe chronic OA-related pain. CONCLUSIONS: Acetaminophen is the mainstay frontline analgesic for treating OA-related pain in older adults. NSAIDs should be limited to short-term use only, and for moderate to severe OA-related pain, opioids may be preferable in individuals without substance abuse or dependence issues.

Melatonin osteoporosis prevention study (MOPS): a randomized, double-blind, placebo-controlled study examining the effects of melatonin on bone health and quality of life in perimenopausal women.

The purpose of this double-blind study was to assess the effects of nightly melatonin supplementation on bone health and quality of life in perimenopausal women. A total of 18 women (ages 45-54) were randomized to receive melatonin (3mg, p.o., n=13) or placebo (n=5) nightly for 6months. Bone density was measured by calcaneal ultrasound. Bone turnover marker (osteocalcin, OC for bone formation and NTX for bone resorption) levels were measured bimonthly in serum. Participants completed Menopause-Specific Quality of Life-Intervention (MENQOL) and Pittsburgh Sleep Quality Index (PSQI) questionnaires before and after treatment. Subjects also kept daily diaries recording menstrual cycling, well-being, and sleep patterns. The results from this study showed no significant change (6-month-baseline) in bone density, NTX, or OC between groups; however, the ratio of NTX:OC trended downward over time toward a ratio of 1:1 in the melatonin group. Melatonin had no effect on vasomotor, psychosocial, or sexual MENQOL domain scores; however, it did improve physical domain scores compared to placebo (mean change melatonin: -0.6 versus placebo: 0.1, P<0.05). Menstrual cycling was reduced in women taking melatonin (mean cycles melatonin: 4.3 versus placebo: 6.5, P<0.05), and days between cycles were longer (mean days melatonin: 51.2 versus placebo: 24.1, P<0.05). No differences in duration of menses occurred between groups. The overall PSQI score and average number of hours slept were similar between groups. These findings show that melatonin supplementation was well tolerated, improved physical symptoms associated with perimenopause, and may restore imbalances in bone remodeling to prevent bone loss. Further investigation is warranted.

Impact of pharmacist interventions on seeking of medical care by migraineurs.

OBJECTIVES: To determine the impact of a pharmacist-led educational intervention on the seeking of medical care from physicians by patients with migraine and identify barriers to migraine care and lapsing from this care. DESIGN: Prospective, multigroup, quasiexperimental. SETTING: Duquesne University in Pittsburgh, November 2004 through June 2005. PARTICIPANTS: 100 university employees and students. Information from the initial interview was used to divide the patients into four groups: (1) not a migraineur, (2) migraineur who is currently consulting a physician for care of headaches (current consulter), (3) migraineur who has not consulted with a physician for more than 12 months concerning headaches (lapsed consulter), and (4) migraineur who has never consulted a physician regarding headache (never consulter). INTERVENTIONS: Verbal counseling by a pharmacist and written education on migraine, as well as self-administered questionnaires. MAIN OUTCOME MEASURES: Participants' physician consultation rates, perceived barriers to physician consultation, and perceived reasons for lapsing from care. RESULTS: Of the 100 headache sufferers who participated in the study, 82 met International Headache Society criteria for migraine, of whom 22 were never consulters and 20 were lapsed consulters. Cross-tabulation and chi-square statistics did not reveal any statistically significant differences between the never-consulter control and intervention groups for 3-month physician consultation rates or intention to seek consultation during the next 6 months; however, 64% of never consulters contacted their physician or expressed intentions to do so after the intervention. The top three barriers to physician consultation identified were misidentifying migraines as headaches (50%), satisfaction with current treatment (45%), and inconvenience of physician consultation (41%). The top three reasons for lapsing from care were reduced frequency of headache (40%), self-identification of effective therapy (40%), and physician-directed effective therapy (30%). Cross-tabulation and chi-square statistics revealed one significant difference among student/employee groups in their identification of barriers. CONCLUSION: This study identified barriers associated with migraineur physician consultation behavior and reasons for lapses in care. The role of pharmacists in encouraging migraineur physician consultation should be further examined.

Development and implementation of a pharmacist-managed university-based wellness center.

OBJECTIVE: To describe the development and implementation of a pharmacist-managed wellness center based on campus within a school of pharmacy. SETTING: Duquesne University Mylan School of Pharmacy, located in Pittsburgh, Pa. PRACTICE DESCRIPTION: University-based employee wellness center, the Academic Research Center for Pharmacy Care, located within a school of pharmacy staffed by clinical practice faculty and student pharmacists. PRACTICE INNOVATION: The campus-based wellness practice integrates public health activities into the pharmacy school curriculum and provides a model that can be adapted for other ambulatory and community practices. INTERVENTIONS: Referral of clients to primary care providers following identification of risk for disease. MAIN OUTCOME MEASURES: Number of screenings; number of clients identified with elevated cholesterol, blood glucose (BG), blood pressure, or weight and referred to primary care providers; and number of student pharmacists participating in wellness experiential rotations. RESULTS: The center conducted more than 19,000 individual screenings on campus, in neighboring communities, and in the western Pennsylvania region from October 2002 through May 2006. During the period July 2005 through May 2006, 16% of those screened required referral for elevated blood pressure (>140/90 mm Hg), 23% required referral for elevated total cholesterol (> 200 mg/dL, the population covers ages 20 to over 70 years), 8% required referral for elevated BG (fasting BG > or =100 mg/dL or nonfasting BG > or =200mg/dL), 43% required referral for low bone density (T-score < or =-1), 21% required referral for abnormal skin findings ranging from dryness to suspicious markings, and 26% required referral for body mass index (> or =30 kg/m2). A total of 70 student pharmacists, divided among two full-time clinical practice faculty, have participated in the wellness clinical rotation since 2004. CONCLUSION: Pharmacists can successfully direct public heath initiatives such as wellness and health promotion programs in an employee-based health center, in the community, and in community pharmacies. Pharmacists are able to identify primary preventive patients for referral to other health care providers.