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1.
J Am Pharm Assoc (2003) ; : 102152, 2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-38964591

RESUMEN

BACKGROUND: Pharmacy has an important role in combating the opioid epidemic. However, there is a need for more consistency of programs and evidence-based practices across the country. OBJECTIVES: To describe how an evidence-based opioid misuse and overdose prevention program that originated in North Dakota was implemented in West Virginia and to compare program results between the two states including pharmacist interventions and patient screening for opioid misuse and overdose. PRACTICE DESCRIPTION: This advancement in practice took place in participating North Dakota and West Virginia community pharmacies. PRACTICE INNOVATION: An evidence-based program that originated in North Dakota was implemented in West Virginia. The details of this collaboration are outlined in this manuscript. EVALUATION METHODS: Program screening and pharmacist intervention data were collected using DocStation, an online pharmacy patient management platform. RESULTS: Thirty-four pharmacies in West Virginia implemented the program. Between April 2022 and September 2023, a total of 34 West Virginia pharmacies conducted 449 documented screenings compared to 12,105 screenings by 81 pharmacies in North Dakota over the same time. There were differences between the states with regard to the proportion of individuals screened as high-risk for OUD and individuals at risk of accidental opioid overdose likely attributable to different demographics. CONCLUSION: An opioid misuse and prevention program was successfully implemented in two states, which can serve as a model to implement similar programs in other pharmacies across the United States.

2.
J Pharm Technol ; 39(1): 3-9, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36755758

RESUMEN

Background: Pharmacy practice continues to expand in scope, and technology platforms to assist with meeting the standards for documentation of billable services are needed. The ONE Program (Opioid and Naloxone Education) is an initiative centered on the community pharmacy focused on opioid risk screening for patients receiving opioid prescriptions. Objective: Opioid risk screening results and pharmacist interventions were documented using first REDCap and later the DocStation platforms. This study compared pharmacy staff experience with these 2 platforms. Methods: A survey using the Technology Acceptance Model (TAM) was designed to compare usability, ease of use, social influence, and facilitating conditions. Results: Analyses using descriptive statistics and open-ended responses showed similar results for each platform; however, pharmacy staff indicated that REDCap required less time when entering information, whereas the DocStation platform offered elevated pharmacy practice service opportunities, management support, and available informational technology support services. Conclusion: Health care technology continues to advance in meeting the needs of expanded service provision through pharmacy. This longitudinal study shows the value of the TAM framework in identifying efficiencies and deficiencies of health care technology systems.

3.
Prev Chronic Dis ; 19: E41, 2022 07 14.
Artículo en Inglés | MEDLINE | ID: mdl-35834737

RESUMEN

INTRODUCTION: Community pharmacies nationwide have adopted new strategies to combat the opioid epidemic. One strategy to prevent opioid misuse and accidental overdose is patient screening to identify those at risk. The purpose of our study was to determine whether such screening in community pharmacies led pharmacy personnel to intervene with patients at risk and to describe the proportion of patients they identified as at risk. METHODS: We implemented the Opioid and Naloxone Education (ONE) program in North Dakota to give community pharmacies and pharmacists training and tools to provide preventive screening for opioid misuse and accidental overdose before dispensing a prescribed opioid. Data were collected and analyzed from September 15, 2018, through May 15, 2021, to evaluate overall patient risk characteristics for opioid misuse and accidental overdose. RESULTS: Of 8,217 patients screened, 3.9% were identified as at high risk for opioid misuse, and 18.3% at risk for accidental overdose. Nearly 1 of 3 screenings (31.7%) indicated opioid medication use in the past 60 days. Pharmacists delivered 1 or more risk-factor-dependent interventions to 41.1% of patients in the study. Following screening, naloxone dispensing in pharmacies increased to 6 times the national average. CONCLUSION: Pharmacy-based patient screening for risk of opioid misuse and accidental overdose led to risk-dependent interventions targeted to individual patients. The tools and risk-dependent interventions applied in the ONE program increased patient awareness of opioid risks and ways to reduce risk. Future studies should examine long-term outcomes, including reduction in overdose, treatment of opioid use disorder, and reduced opioid-related acute care.


Asunto(s)
Trastornos Relacionados con Opioides , Farmacias , Analgésicos Opioides , Humanos , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Farmacéuticos
4.
Subst Abus ; 43(1): 1051-1056, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35435816

RESUMEN

Background: Pharmacist stigma via examination of social distance preference and negative attitudes toward persons who misuse opioids is prevalent and may lower the quality of care provided to patients. Few studies have previously extended beyond the immediate post-intervention period to examine stigma change. Methods: This longitudinal cohort study utilized a pre-survey administered before the training program, a post-survey immediately upon completion of the training program, and a delayed post-survey, administered 12 months after the training program. Co-primary outcomes were changes in social distance scale (SDS) total score from baseline to post-survey and from baseline to 12 months. Secondary outcomes included change in SDS question scores and change in negative attitudes. One hundred eighty-seven of the 1211 eligible pharmacists in the state completed the training. Matched responses of forty-four pharmacists who completed all three surveys were examined. Results: The mean total SDS score was significantly lower in the immediate post-training survey than the pre-training mean (14.75 vs. 16.57, p = .000). The 12 months mean total SDS score was also significantly lower than the pre-training mean (15.32 vs. 16.57, p = .017). Significant changes in negative attitudes from baseline to post-survey and from baseline to 12 months were seen. Conclusion: Stigma reduction components integrated into opioid training decreased pharmacist social distance preference and negative attitudes toward patients who misuse opioids immediately after the training and, most notably, were sustained for 12 months.


Asunto(s)
Trastornos Relacionados con Opioides , Farmacéuticos , Analgésicos Opioides/uso terapéutico , Actitud del Personal de Salud , Humanos , Estudios Longitudinales , Trastornos Relacionados con Opioides/tratamiento farmacológico
5.
J Am Pharm Assoc (2003) ; 62(3): 859-863.e1, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34953730

RESUMEN

BACKGROUND: Pharmacist-implemented screening programs can be improved through continuous program evaluation. Pharmacists are in a position to determine whether interventions are realistic and efficacious when used in practice. OBJECTIVE: The purpose of this study is to evaluate how community pharmacists perceive the use of an opioid risk screening for patients receiving opioid prescriptions and the associated implications for improved patient-centered care. METHODS: North Dakota community pharmacists received training on the use of an opioid risk tool for all patients filling an opioid prescription to evaluate for opioid misuse and overdose risk potential. Pharmacists then implemented the screening in their community pharmacy to screen all patients prescribed an opioid. Six months after implementation, pharmacists across the state were surveyed regarding their perception of the value of screening patients for the risk of opioid misuse and overdose. The survey questions used the Joint Committee on Standards for Educational Evaluation focusing on utility, propriety, feasibility, and accuracy. RESULTS: All pharmacists (n = 35) indicated the opioid risk screening improved patient communication and patient-centered interventions. A total of 97% of pharmacists agreed the opioid screening tool provided an objective measure in providing care to patients and improved the potential for patient safety during prescription opioid use. Although 66% of pharmacists disagreed that the screening process was time consuming, 14% of respondents agreed with this statement indicating they may require additional assistance to optimize their workflow. CONCLUSION: The results of this study support that opioid risk screening ensures utility for opioid risk stratification, feasibility to incorporate into existing workflow, and propriety for patient safety and well-being.


Asunto(s)
Sobredosis de Droga , Trastornos Relacionados con Opioides , Analgésicos Opioides/efectos adversos , Sobredosis de Droga/tratamiento farmacológico , Humanos , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/prevención & control , Farmacéuticos , Evaluación de Programas y Proyectos de Salud
6.
Subst Abus ; 42(4): 672-677, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33044896

RESUMEN

Background: Community pharmacists are in a unique position to prevent opioid-related deaths through the provision of naloxone. However, for those identified as candidates for take-home naloxone, the acceptance rate remains low. Value would be gained from knowing what patient demographics and pharmacist actions are associated with increased patient acceptance of naloxone. Methods: Through a state-wide program, community pharmacists screened all patients receiving an opioid prescription for risk of opioid misuse and/or accidental overdose. Pharmacists prescribed and/or dispensed take-home naloxone to patients at elevated risk. Naloxone acceptance rates were stratified based on risk factors for misuse and overdose to determine which patients are most likely to accept naloxone. Patient acceptance of naloxone and risks were captured electronically. Results: Pharmacist-initiated naloxone recommendations based on risk screening resulted in a 5.81% take-home naloxone acceptance rate. Individuals that were taking multiple opioid medications were most likely to accept the naloxone (20.45%). Concurrent disease states or medications (COPD, concurrent anxiety/depression medication, concurrent sleep aid) were associated with a statistically significant increase in the rate of naloxone acceptance. Acceptance of take-home naloxone increased as a patient risk for opioid misuse and/or accidental overdose increased. Conclusion: Patient acceptance of naloxone at the community pharmacy level was notably higher compared to national naloxone dispensing rates when pharmacists implemented a patient screening and systematic risk-based approach to identify candidates in need of take-home naloxone.


Asunto(s)
Sobredosis de Droga , Trastornos Relacionados con Opioides , Analgésicos Opioides/efectos adversos , Sobredosis de Droga/tratamiento farmacológico , Sobredosis de Droga/prevención & control , Humanos , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/prevención & control , Farmacéuticos
7.
Subst Abus ; 42(4): 919-926, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33750283

RESUMEN

Background: Health professionals may stigmatize and prefer social distance from patients with opioid misuse, leading to poorer quality of care provided. The degree to which pharmacists prefer social distance from patients with opioid misuse and opioid use disorder (OUD) is not known. Methods: Pharmacists (n = 187) completed a survey comprised of demographics, attitudinal, and Social Distance Scale (SDS) questions based on a vignette patient who displayed opioid misuse. SDS question responses and total scores (maximum of 30; higher scores representing great preference for social distance) were tallied and associations with attitudes and demographics were examined. Results: Mean SDS total score was 16.32 (range 9-23). More than 59% of respondents had an SDS score >15, indicating overall lack of willingness to interact with the vignette patient. Females had a higher mean SDS score vs male pharmacists (16.58 vs. 15.36, respectively; p = 0.023). Pharmacists were more likely to prefer social distance from the vignette patient in personal situations (i.e. renting a room) than work-related interactions (i.e. providing patient education). Pharmacists with >10 years of experience, those without personal experience with a substance use disorder, those who strongly agreed that patients with OUD require excessive time and effort, and those who agreed that some people lack self-discipline to use prescription pain medication without becoming addicted had significantly higher SDS scores than pharmacists without these characteristics. Conclusions: Pharmacists expressed significant preference for social distance indicating stigmatization of patients with opioid misuse. Pharmacists were comfortable performing pharmacy tasks with patients with opioid misuse, but were less comfortable forming therapeutic relationships, an important tenet of patient-centered care. Efforts are needed to examine contributions to social distance preferences and implement measures to reduce them. Targeting of pharmacists with >10 years' experience and without personal experience with OUD may also be most beneficial.


Asunto(s)
Trastornos Relacionados con Opioides , Farmacéuticos , Analgésicos Opioides/uso terapéutico , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Trastornos Relacionados con Opioides/tratamiento farmacológico , Estigma Social , Estereotipo
8.
J Am Pharm Assoc (2003) ; 60(1): 117-121, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31677933

RESUMEN

OBJECTIVE: To describe the implementation of a statewide pharmacy program called ONE Rx (Opioid and Naloxone Education) within community pharmacies. SETTING: Thirty community pharmacies. PRACTICE DESCRIPTION: Community pharmacies throughout the state of North Dakota were invited to participate. Pharmacists in North Dakota can legally prescribe and dispense naloxone. PRACTICE INNOVATION: ONE Rx is a statewide program that provides pharmacists with the education and tools to screen every patient who was prescribed an opioid medication for the risk of opioid misuse and accidental overdose. The goal of ONE Rx is to prevent opioid misuse and accidental overdose through patient screening and individualized education and intervention within the community pharmacy. EVALUATION: Outcomes to measure the implementation of ONE Rx included the number of pharmacists and technicians who participated in the training, the number of pharmacies who chose to implement ONE Rx, and the number of patients screened for the risk of opioid misuse and accidental overdose. RESULTS: The ONE Rx training was completed by 240 pharmacists and 41 registered pharmacy technicians. Thirty community pharmacies implemented the program between October 2018 and May 2019, and more than 1700 patients were screened for the risk of opioid misuse and accidental overdose. CONCLUSION: A statewide program to screen for opioid misuse and accidental overdose was successfully implemented.


Asunto(s)
Sobredosis de Droga , Trastornos Relacionados con Opioides , Farmacias , Analgésicos Opioides/efectos adversos , Sobredosis de Droga/tratamiento farmacológico , Sobredosis de Droga/prevención & control , Humanos , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , North Dakota , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/prevención & control , Farmacéuticos
9.
Qual Health Res ; 27(13): 1959-1969, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29088990

RESUMEN

Previous work has reported that medication experience may affect medication-related problems, adherence, and quality of life. The purpose of this study was to explore medication experience of individuals taking psychotropic medication from the patient perspective using photovoice methodology. Nineteen participants were given a camera and were asked to photograph their medication experience. Individual and focus group sessions were held for photo reflection and discussion. Transcript data were analyzed to arrive at a model of medication experience. Specific medication experiences, including recognizing medication's benefits, occurrence of side effects, developing medication-taking routine, feeling burden from medications, and benefiting from nonmedication therapies, influenced medication acceptance, but in varying ways. Participants wanted their providers to understand their medication experience. Health care providers should consider exploring medication experience of patients with mental illness. Additional research is needed to evaluate whether exploring patients' medication experience in the clinical setting can improve patient-centered health care outcomes.


Asunto(s)
Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/psicología , Aceptación de la Atención de Salud/psicología , Fotograbar , Psicotrópicos/uso terapéutico , Adulto , Femenino , Grupos Focales , Humanos , Masculino , Investigación Cualitativa , Calidad de Vida
10.
J Psychosoc Nurs Ment Health Serv ; 54(1): 56-63, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26565416

RESUMEN

The purpose of the current study was to assess the frequency and distribution of the 9-Item Patient Health Questionnaire (PHQ-9) among individuals with type 2 diabetes with and without depression. The current case-control study used electronic medical record data from two primary care institutions. The sample was divided into cases with coexisting depression and type 2 diabetes and controls without depression. Data included demographics, biomarkers, number of services delivered, and clinic visits in 2013. Similar PHQ-9 use was seen between unique primary care practices. However, less than one third of patients at either site received depression screening with the PHQ-9 in 2013. Male and older adult patients were less likely to receive assessment. Guideline ambiguity and lack of accountability in primary care practice has made the use of depression metrics arbitrary in diabetic populations at risk for depression. To assure adequate care provision, it is imperative that proven tools for assessing depressive symptoms are used.


Asunto(s)
Trastorno Depresivo/diagnóstico , Diabetes Mellitus Tipo 2/complicaciones , Evaluación en Enfermería , Escalas de Valoración Psiquiátrica , Encuestas y Cuestionarios , Adulto , Anciano , Estudios de Casos y Controles , Centros Comunitarios de Salud , Diabetes Mellitus Tipo 2/psicología , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Atención Primaria de Salud , Estudios Retrospectivos
11.
J Pharm Pract ; 36(5): 1217-1224, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-35704458

RESUMEN

Background: Screening for patient-level opioid-related risk in the community pharmacy setting has increased patient education about opioids and naloxone distribution, helping to mitigate the impact of the opioid epidemic. However, patient experience and satisfaction with opioid screening and education is unknown. Fear of patient dissatisfaction may limit pharmacists' willingness to implement screening activities. Objective: To report patient experience and satisfaction of a convenience sample of patients undergoing screening and intervention for opioid-related risk as a part of the ONE Program (formerly ONE Rx). Methods: Patients who received ONE Program screening and intervention from their community pharmacist were recruited to participate in a 9 item survey regarding their experience and satisfaction. Results were analyzed by urban and rural location of participants. Results: Urban (n = 42) and rural (n = 32) patients who completed the survey reported positive experiences namely feeling comfortable with the ONE process (86.5%), the process taking an appropriate amount of time (93.2%) and feeling safer as a result of their pharmacist's attention to their opioid-related medication risk (86.3%). Urban patients were significantly more likely than rural patients to report positive attitude and behavior changes as a result of the ONE process. Conclusion: High levels of patient satisfaction and positive experience with the ONE Program screening and intervention process for patient-level opioid-related risks may encourage community pharmacists to more broadly implement such activities.


Asunto(s)
Servicios Comunitarios de Farmacia , Trastornos Relacionados con Opioides , Farmacias , Humanos , Analgésicos Opioides/efectos adversos , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/tratamiento farmacológico , North Dakota , Satisfacción del Paciente , Farmacéuticos , Satisfacción Personal , Evaluación del Resultado de la Atención al Paciente
12.
J Pharm Pract ; : 8971900221144183, 2022 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-36472932

RESUMEN

Introduction: There are limited publications supporting the use of screening tools to implement upstream prevention of opioid-related problems. Opioid and Naloxone Education (ONE) is utilized in outpatient pharmacies to screen and identify patients at risk of opioid-related problems and make interventions. Objectives: To implement ONE in the inpatient setting to promote prevention of opioid-related problems and overdose risk mitigation. Methods: For this pilot, ONE screening tool was completed via chart review and patient interview for inpatients prescribed an opioid. Risk scores were calculated and recommendations were provided. Outcomes evaluated included morphine milligram equivalents (MME) prior to hospitalization, inpatient screening pre-, post-, and at discharge; naloxone orders at discharge; and comparison of overdose risk from different sources. Results: The control group (n = 44) had a mean MME decrease of 1.5, and following implementation of pharmacist interventions, the experimental group (n = 45) observed a mean MME decrease of 28.6 (P = .0001). For the threshold of 50 MME, 8.6% of patients in the control group had a change from >50 MME to <50 MME at 24 hour follow up. This change occurred in 29% of patients in the experimental group (P = .03). For non-opioid analgesics, 6.8% of patients in the control group had non-opioid analgesic orders added or increased compared to 26.6% in the experimental group (P = .01). Conclusion: Screening for opioid misuse and accidental overdose risk appears impactful in the inpatient setting. Screening and appropriate risk-based intervention was associated with decreases in total daily MME and increased non-opioid analgesics.

13.
Ment Health Clin ; 12(2): 77-85, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35582321

RESUMEN

Psychiatric pharmacy continues to grow and look to the future with a focus on helping individuals recover from mental health and substance use disorders. The American Association of Psychiatric Pharmacists (AAPP) considers Board Certified Psychiatric Pharmacist (BCPP) the gold standard credential that all psychiatric pharmacists should attain to demonstrate specialized knowledge and expertise in psychiatry. BCPPs are part of collaborative interprofessional teams and practice in hospitals, clinics, and diverse health systems. Two out of 3 BCPPs practicing in clinics have prescriptive authority. BCPPs improve access, safety, medication adherence, and therapeutic outcomes. Every person with a mental health and substance use disorder should have access to a BCPP providing comprehensive medication management (CMM) and psychotropic stewardship aimed at improving population health. BCPPs are in demand owing to their expertise. AAPP envisions growth and expansion of the BCPP role in many areas including coordinating psychiatric transitions of care and telehealth services, managing long-acting injectable medication clinics, providing pharmacogenomic consultation, conducting clozapine and lithium monitoring, managing medications for substance use disorders, leading medication groups, CNS drug development, research, and provider education. To prepare the workforce, colleges and schools of pharmacy should hire BCPPs for optimal curriculum development, and each student pharmacist should have an opportunity to develop a therapeutic alliance with a person recovering from psychiatric illness. Postgraduate year (PGY) 1 residencies should offer learning experiences in psychiatric pharmacy to prepare residents to enter an expanded number of PGY2 psychiatric pharmacy residencies, ultimately earning their BCPP and being well positioned to improve mental health care.

14.
Psychiatr Serv ; 73(11): 1294-1297, 2022 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-35502518

RESUMEN

Pharmacists tend to provide care to patients with psychiatric disorders less frequently than to other types of patients, yet patients with psychiatric disorders experience more drug-related problems and use more opioids than those without psychiatric disorders. The Opioid and Naloxone Education (ONE) program equipped pharmacists to screen for opioid misuse and overdose risk and to implement a set of interventions for any patient filling an opioid prescription. Patients with a psychiatric disorder (N=1,980; 24.1% of those screened) were significantly more likely to receive more than one intervention from a ONE program pharmacist than were those without a psychiatric disorder. The use of an objective screening tool and training in stigma reduction and nonjudgmental communication approaches, which are part of the ONE program process, deserve further exploration as ways to increase the frequency of pharmacist-provided education and other critical interventions for patients with psychiatric disorders.


Asunto(s)
Sobredosis de Droga , Trastornos Relacionados con Opioides , Humanos , Analgésicos Opioides/efectos adversos , Farmacéuticos , Antagonistas de Narcóticos/uso terapéutico , Naloxona/uso terapéutico , Sobredosis de Droga/prevención & control , Trastornos Relacionados con Opioides/tratamiento farmacológico , Prescripciones
15.
Innov Pharm ; 13(4)2022.
Artículo en Inglés | MEDLINE | ID: mdl-37305591

RESUMEN

Objective: To evaluate the impact of an emergency department simulation on pharmacy students' interprofessional team skills and attitudes as measured by a novel mixed methods approach. Methods: A simulated emergency department encounter was executed by interprofessional teams consisting of pharmacy and medical students. Two rounds of the same encounter were separated by a short debriefing session facilitated by pharmacy and medical faculty. A full, comprehensive debriefing session occurred after conclusion of the second round. Pharmacy faculty evaluated pharmacy students using a competency-based checklist after each round of the simulation. Pharmacy students completed a baseline self-assessment of their interprofessional skills and attitudes pre-simulation, and again post-simulation. Results: Pharmacy students demonstrated significant improvement in providing clear and concise verbal interprofessional communication and using shared decision making to develop a collaborative plan of care, based upon student self-assessment and faculty observational ratings. Student self-assessments also showed significant perceived growth in contributing to the team's plan of care, and demonstrating active listening skills within the interprofessional team. Through qualitative analysis, pharmacy students noted perceived self-improvement in a variety of team-based skills and attitudes including confidence, critical thinking, role identification, communication, and self-awareness. Conclusion: This simulation provided a learning opportunity for pharmacy students to improve their skills related to teamwork and interprofessional collaboration. Based upon a novel a mixed methods assessment, both student self-assessment and faculty observational ratings were associated with significant growth in interprofessional skills and attitudes. This simulation provides a template experience for colleges/schools to meet, at least in part, ACPE Standards related to interprofessional education in collaboration with medical students.

16.
Res Social Adm Pharm ; 18(12): 4065-4071, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35941069

RESUMEN

OBJECTIVE: The objective for this paper is to report on the utility of the Opioid Risk Tool (ORT) to identify patients at elevated risk for opioid misuse and deliver medication safety-related services to them. Patient characteristics based on ORT risk stratification are also described. METHODS: Data from patients screened from September 17, 2018 to May 12, 2021 were descriptively evaluated for distribution of ORT scores, characteristics of patients stratified by ORT score, and services delivered to patients based on ORT score. The ORT generates a score from 0 to 26, with scores of 0-3, 4-7, and 8 or higher representing low, moderate, and high risk of opioid use disorder, respectively. Based upon screening results, pharmacists provided patient-specific education and interventions. RESULTS: A total of 6,460 patients were evaluated. Low, moderate, and high ORT scores were found among 87.5, 8.2 and 3.9% of the patients receiving opioids, respectively. Males comprised 46.1% of the patients, and 27.7% of the patients had received a prior opioid prescription in the last 60 days. As a result of risk stratification, the pharmacist explained opioid use disorder to 18.8, 36.1, and 47.0% of patients with low, moderate and high ORT scores, respectively (p < .001). High ORT scores were significantly associated with the pharmacist introducing the patient to community support services (OR = 2.35), the pharmacist having contacted their provider (OR = 6.41), male gender (OR = 2.06), and having taken an opioid in the last 60 days (OR = 1.76). CONCLUSIONS: The ORT is a useful tool for opioid risk stratification of patients receiving opioid medications in the community pharmacy setting. Such stratification allows the pharmacist to provide individualized services to patients based on their risk profile.


Asunto(s)
Trastornos Relacionados con Opioides , Farmacias , Humanos , Masculino , Femenino , Analgésicos Opioides/efectos adversos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Farmacéuticos , Medición de Riesgo/métodos
17.
Res Social Adm Pharm ; 17(12): 2062-2069, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34172400

RESUMEN

Photovoice is a qualitative research method where people, through images (photography, drawings or paintings), capture, represent, and communicate their experiences and perspectives about issues that are important to them with the final goal of raising awareness and triggering social change. Photovoice is informed by participatory action research approaches, feminist theory, Paulo Freire's critical pedagogy, and the theory of photography. Developed with the explicit purpose of gathering voices to advocate for structural social change in the early 1990s, the application of Photovoice in projects related to social pharmacy research started approximately 15 year later. The first Photovoice studies within social pharmacy aimed at understanding patients' experiences with their medications. Photovoice has also been integrated in interventions mainly focused on enhancing adherence to pharmacological treatments. There is still, however, room to fully unfold the empowering and emancipatory potential of Photovoice within social pharmacy research. This article briefly presents the theories underlying Photovoice, a guide for its appropriate methodological and ethical implementation, and with the aim to serve as inspiration for future social pharmacy research projects, it also includes three previously published studies that used Photovoice to understand, raise awareness and trigger social change to facilitate better lives when in need of pharmacological treatments.


Asunto(s)
Participación de la Comunidad , Fotograbar , Humanos , Proyectos de Investigación
18.
Am J Pharm Educ ; 85(7): 8354, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34544737

RESUMEN

One in five Americans has a diagnosable mental illness, and pharmacists encounter these patients daily. This commentary addresses the conflict between the profession's wellness movement and its ongoing contribution to mental illness stigma. The need for improved pharmacist wellness is based on the profession's risk for burnout and development of related mental illness. The presence of stigma towards patients with mental illness among pharmacists is multi-factorial and complex. Risk of those within the profession perpetuating mental illness stigma could be diminished by developing pharmacy curricula that provide greater opportunities for students to learn more completely about mental illness, how to effectively engage persons with mental illness, and how to take care of themselves, express vulnerability, and talk about mental illness. While reducing mental illness stigma through curricular revision is best achieved through in-person learning experiences, elective coursework and cocurricular activities may also help achieve this goal. Examples of evidence-based best practices are provided.


Asunto(s)
Educación en Farmacia , Trastornos Mentales , Actitud del Personal de Salud , Humanos , Farmacéuticos , Estigma Social
19.
Psychiatr Serv ; 72(7): 794-801, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-33940946

RESUMEN

Although approximately 20% of adults in the United States experience a mental health condition annually, there continues to be a gap in the provision of care because of a shortage of behavioral health providers. The National Council for Behavioral Health Medical Director Institute has recommended that the number of board-certified psychiatric pharmacists (BCPPs), who are clinical pharmacists with advanced specialized training and experience in the treatment of patients with psychiatric and substance use disorders, be expanded to help meet this need. Although BCPPs currently assist in expanding care access, improving medication-related outcomes, and reducing health care costs by working collaboratively with physicians and other health care providers, BCPPs are often underutilized. This lack of utilization results in lost opportunity to better address the needs of persons with psychiatric or substance use disorders and to meet these needs in a timely manner. Here, the authors bring attention to five key areas-opioid use disorder, antipsychotic use among children, long-acting injectable antipsychotics, clozapine use, and transitions of care and care coordination-in which BCPPs, along with other pharmacists, provide evidence-based care and could be more extensively used as a collaborative solution to the mental health and substance use disorder crisis in the United States.


Asunto(s)
Antipsicóticos , Psiquiatría , Adulto , Certificación , Niño , Accesibilidad a los Servicios de Salud , Humanos , Farmacéuticos , Estados Unidos
20.
Am J Pharm Educ ; 84(4): 7599, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32431307

RESUMEN

Objective. To compare the effectiveness of photovoice with traditional reflection as a methodology to identify student learning during an international advanced pharmacy practice experience (APPE). Methods. Over seven years, seven cohorts of two to three pharmacy students completed an APPE in which they participated in a medical mission trip to Guatemala. Cohorts were assigned to use either photovoice or traditional reflection techniques to identify and document their learning. After returning from the mission trip, a focus group was conducted with each cohort of students. Students' comments were audio-recorded and the audio recording was transcribed and the text was qualitatively analyzed. In addition, all students completed the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC-SV) before and after travel. Results. All 18 students who participated in the mission trips, (nine in each group) agreed to participate in the study. Several themes were identified when the transcripts of the focus group sessions were reviewed. Students in both groups emphasized learning about the enhancement of pharmacy skills, cultural appreciation, and self-examination in their reflections. However, students in the photovoice group emphasized three additional areas that were not emphasized by students in the traditional reflection group: emotional impact, critical reflection on privilege, and ethical distribution of health resources. Students' post-intervention mean scores on the IAPCC-SV increased more for the photovoice group (8.5 points) than the reflection group (6.8); however, this difference was not significant. Conclusion. Students who used photovoice focused more on the connection between their learning and emotional or moral experiences than did students who used traditional reflection techniques. Photovoice may represent a promising methodology for deeper reflection into affective learning domains because of students' connection between visual images and their lived experiences.


Asunto(s)
Misiones Médicas , Narración , Fotograbar , Aprendizaje Basado en Problemas , Estudiantes de Farmacia/psicología , Adulto , Actitud del Personal de Salud , Competencia Clínica , Asistencia Sanitaria Culturalmente Competente , Emociones , Femenino , Grupos Focales , Guatemala , Humanos , Masculino , Rol Profesional , Investigación Cualitativa , Estados Unidos , Escritura , Adulto Joven
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