When a Pharmacist Health Assessment Simulation Becomes a Real Patient-Provider Experience.

This commentary presents two simulated pharmacist training events during which concerning medical issues were discovered. The simulation exercises, the pharmacist's responsibility in those exercises, and the need to plan for unexpected findings when conducting simulation events are discussed.

The Impact of Eliminating Backward Navigation on Computerized Examination Scores and Completion Time.

Objective. To determine whether elimination of backward navigation during an examination resulted in changes in examination score or time to complete the examination.Methods. Student performance on six examinations in which backward navigation was eliminated was compared to performance on examinations administered to pharmacy students the previous year when backwards navigation was allowed. The primary comparison of interest was change in student performance on a subset of identical questions included on both examinations. Secondary outcomes included change in total examination score and completion time.Results. No significant reduction in examination scores was observed as a result of eliminating backward navigation. The average time that students spent on a question was significantly reduced on two of the six examinations.Conclusion. Restricting pharmacy students' ability to revisit questions previously answered (elimination of backward navigation) on an examination had no adverse effect on scores or testing time when assessed across three years of the didactic pharmacy curriculum.

Reflections on 500 Call-in Radio Shows.

Pharmacy educators, whether in didactic classes, laboratory settings, or experiential opportunities, search for ways to incorporate "real life" patient questions and concerns into the educational process. This practice not only enhances the educational opportunities for students, it also prepares them for questions and concerns that they will inevitably face as practicing professionals. This commentary describes listener calls from 500, live, call-in radio shows. There is no accurate way to directly assess information that patients do not know or understand. The author suggests using commonly asked pharmacy-based questions, directly from the public, as a proxy to identify the information most desired by patients. The author assumes that radio callers are not calling to ask questions when they already know the answers. Thus, having identified the information most desired by radio-show callers, pharmacist educators, no matter the setting, can be provided with a ready-made resource that lists the most common concerns from over 6,000 radio callers. The author recommends educators use this resource and apply real patient questions and concerns during the educational process, furthermore, opportunities to use this resource are provided.

Improving access to appropriate post-exposure doxycycline for Lyme disease prophylaxis: role for community pharmacies.

The transmission of Borrelia burgdorferi to humans through tick bites results in Lyme disease. Appropriate therapy for Lyme disease is antibacterial drugs, most often doxycycline. Patients often approach community pharmacists for self-care assistance with the symptoms of Lyme disease: fever, headache, fatigue and skin rash. Pharmacists with the patient history are trained and capable of appropriately dispensing doxycycline to treat these patients and prevent the spread of infection to the joints, nerves or heart. We challenge restrictions to the appropriate and timely provision of therapy for Lyme disease and encourage the use of community pharmacists in managing these patients.

The Roles of Pharmacy Schools in Bridging the Gap Between Law and Practice.

Progressive pharmacy laws do not always lead to progressive pharmacy practice. Progressive laws are necessary, but not sufficient for pharmacy services to take off in practice. Pharmacy schools can play critical roles by working collaboratively with community pharmacies to close the gap between law and practice. Our experiences launching pharmacy-based point-of-care testing services in community pharmacy settings illustrate some of the roles schools can play, including: developing and providing standardized training, developing template protocols, providing workflow support, sparking collaboration across pharmacies, providing policy support, and conducting research.

Pharmacy-Based Travel Health Services: State Approaches to Prescriptive Authority.

Pharmacists have provided travel health services in some capacity for more than 25 years. The ability of pharmacists to autonomously prescribe travel medications is growing. Three states (California, Idaho, and New Mexico) allow pharmacists to autonomously prescribe medications for international travel using the Centers for Disease Control and Prevention Yellow Book as a guide. Idaho also allows pharmacists to autonomously prescribe select medications appropriate to domestic travel (motion sickness prevention and Lyme disease prophylaxis), and Florida allows for the prescribing of drugs for motion sickness. Core elements from each state law including education, patient assessment, provider notification, and documentation are reviewed.

Observation of a Pharmacist-Conducted Group A Streptococcal Pharyngitis Point-of-Care Test: A Time and Motion Study.

BACKGROUND: Acute pharyngitis is among the most common infectious diseases encountered in the United States, resulting in 13 million patient visits annually, with group A streptococcus (GAS) being a common causative pathogen. It is estimated that annual expenditures for the treatment of adult pharyngitis will exceed US$1.2 billion annually. This substantial projection reinforces the need to evaluate diagnosis and treatment of adult pharyngitis in nontraditional settings. OBJECTIVE: The objective of this research is to quantify the amount of pharmacist time required to complete a point-of-care (POC) test for a patient presenting with pharyngitis symptoms. METHODS: A standardized patient with pharyngitis symptoms visited 11 pharmacies for POC testing services for a total of 33 patient encounters. An observer was present at each encounter and recorded the total encounter time, divided into 9 categories. Pharmacists conducted POC testing in 1 of 2 ways: sequence 1-pharmacists performed all service-related tasks; sequence 2-both pharmacists and pharmacist interns performed service-related tasks. RESULTS: The average time for completion of a POC test for GAS pharyngitis was 25.3 ± 4.8 minutes. The average pharmacist participation time per encounter was 12.7 ± 3.0 minutes (sequence 1), which decreased to 2.6 ± 1.1 minutes when pharmacist interns were involved in the testing (sequence 2). CONCLUSION: Although additional studies are required to further assess service feasibility, this study indicates that a GAS POC testing service could be implemented in a community pharmacy with limited disruption or change to workflow and staff.

Utilization of influenza and streptococcal pharyngitis point-of-care testing in the community pharmacy practice setting.

BACKGROUND: One way to reduce the complications and costs of influenza like illness and pharyngitis is to improve access to testing and treatment in early stages of infection. Pharmacy-based screening and treatment of group A streptococcus (GAS) infection and influenza has the potential to improve patient care and population health. OBJECTIVE: To improve patient care and population health, the objective of this retrospective study was to assess if a previously validated service model could be implemented by pharmacy chains without mandated standardization. METHODS: Researchers utilized a certificate program to provide initial training to pharmacists and shared templates from previous validated models. Pharmacy companies were responsible for navigation of all implementation within their company. Researchers analyzed the de-identified data from patients seeking point-of-care testing from the participating pharmacies. RESULTS: Participating pharmacies reported 661 visits for adult (age 18 and over) patients tested for influenza for GAS pharyngitis. For the GAS patients, 91 (16.9%) tested positive. For the Influenza patients, 22.9% tested positive and 64 (77.1%) testing negative. Access to care was improved as patients presented to the visit outside normal clinic hours for 38% of the pharmacy visits, and 53.7% did not have a primary care provider. CONCLUSION: A collaborative care model for managing patients with symptoms consistent with influenza or group A streptococcus can be successfully implemented, and improve access to care outside of normal clinic hours and for those without a regular primary care provider.

Community pharmacist-physician collaborative streptococcal pharyngitis management program.

OBJECTIVES: To describe patient outcomes associated with a community pharmacy-based, collaborative physician-pharmacist group A Streptococcus (GAS) management program. SETTING: Fifty-five chain and independent community pharmacies in Michigan, Minnesota, and Nebraska. PRACTICE INNOVATION: Pharmacists screened clinically stable adult patients who presented with signs and symptoms consistent with GAS pharyngitis from October 1, 2013, to August 1, 2014, by means of Centor criteria, and performed a physical assessment followed by a rapid antigen detection test (RADT) for eligible patients. Patients were treated according to a collaborative practice agreement (CPA) with a licensed prescriber or a physician consult site model. Pharmacists followed up with patients 24-48 hours after the encounter to assess patient status and possible need for further intervention. EVALUATION: Number of patients screened, tested, and treated, and health care utilization. RESULTS: Of 316 patients screened, 43 (13.6%) were excluded and referred for care. Of 273 patients (86.4%) eligible for testing, 48 (17.6%) had positive test results and 46 (16.8%) received amoxicillin or azithromycin per the CPA. Of those tested, 43.2% had no primary provider and 43.9% visited the pharmacy outside of traditional clinic office hours. CONCLUSION: Pharmacists demonstrated the ability and capacity to provide care for patients seeking treatment for pharyngitis. The number of patients without a primary care provider and seen at the pharmacy outside of normal office hours highlights the improved access that community pharmacy-based care offers.

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness.

OBJECTIVES: To examine the effectiveness of collaborative physician-community pharmacist programs to treat influenza-like illness (ILI) with respect to clinical outcomes and health care utilization. DESIGN: Prospective multicenter cohort study. SETTING: Fifty-five pharmacies in Michigan, Minnesota, and Nebraska. PATIENTS: Adult patients presenting to the pharmacy with ILI during the 2013-14 influenza season (October 1, 2013 to May 30, 2014). INTERVENTION: Pharmacists screened adult patients presenting with ILI, completed a brief physical assessment, performed a point-of-care rapid influenza diagnostic test (RIDT), and provided appropriate referral or treatment per an established collaborative practice agreement (CPA) with a licensed prescriber. Pharmacists followed-up with patients 24 to 48 hours after the encounter to assess patient status and possible need for further intervention. MAIN OUTCOME MEASURES: Number of patients screened, tested, and treated for influenza. RESULTS: Of the 121 patients screened, 45 (37%) were excluded and referred to their primary care provider or an urgent care facility for management. Of the 75 patients (62%) eligible for participation, 8 (11%) had a positive RIDT and were managed according to the CPA. Of the patients tested, 34.6% had no primary care physician and 38.7% visited the pharmacy outside of normal office hours. Only 3% of patients reported feeling worse at follow-up. CONCLUSION: This study describes a physician-pharmacist collaborative model for treating ILI. Using an evidence-based CPA, pharmacists were able to provide timely treatment to patients with and without influenza.

Health Care Resource Utilization and Costs for Influenza-like Illness Among Midwestern Health Plan Members.

BACKGROUND: Each year, 6%-20% of U.S. residents are infected by influenza, and more than 200,000 people are hospitalized due to complications related to influenza. In 2003, it was estimated that the direct medical costs for the treatment of influenza were $10.4 billion in the United States.  OBJECTIVES: To (a) assess the current practice associated with the diagnosis and treatment of influenza-like illnesses (ILIs) in inpatient, ambulatory/outpatient, and emergency room settings and (b) evaluate how the use of rapid influenza diagnostic tests (RIDTs) impacts patient health care utilization and cost in these clinical settings. METHODS: For this retrospective cohort study, patients with an influenza-related health care encounter were identified using claims data from a midwestern commercial health insurance plan. In order to select the claims relevant to this study, the corresponding influenza ICD-9-CM codes, GPI codes, and CPT codes for the diagnosis, prescriptions, and procedures were identified and used to detect ILI claims. For the cost analysis of these data, the allowed amount in the billing claims was utilized. Using these data, the median cost, mean cost, minimum cost, and maximum cost were determined for each episode of care. The median costs were compared, and Wilcoxon two-sample tests and Kruskal-Wallis tests with a P value of 0.05 were used as the level of significance. RESULTS: Over 32% of the influenza-like illness episodes identified in this study involved empiric antiviral therapy as either treatment (15%) or prophylaxis (17.1%) without an accompanying medical visit. Of patient episodes with a medical visit, patients with an RIDT for influenza received antiviral treatment in 27.5% of the episodes compared with 55% of the episodes for patients with no RIDT. Episodes with a medical visit and an RIDT had statistically significant (P less than 0.001) lower median 30-day influenza-related health care costs ($62.46) than episodes with a medical visit but no RIDT ($192.83), as well as with empiric therapy but no accompanying medical visit ($105.64). CONCLUSIONS: The results of this analysis for ILI claims over a 2-year period suggest that utilization of RIDTs for influenza may reduce overall influenza-related health care costs and improve proper utilization of anti- influenza medications.

Point-of-care testing for infectious diseases: opportunities, barriers, and considerations in community pharmacy.

OBJECTIVES To identify opportunities to perform point-of-care (POC) testing and/or screening for infectious diseases in community pharmacies, provide an overview of such tests and how they are used in current practice, discuss how the Clinical Laboratory Improvement Amendments of 1988 (CLIA) affect pharmacists performing POC testing, and identify and discuss barriers and provide recommendations for those wanting to establish POC testing for infectious diseases services in community pharmacies. DATA SOURCES PubMed and Google Scholar were searched from November 2012 through May 2013 and encompassed the years 2000 and beyond for the narrative review section of this article using the search terms rapid diagnostic tests, POC testing and infectious diseases, pharmacy services, CLIA waiver, and collaborative drug therapy management. All state boards of pharmacy in the United States were contacted and their regulatory and legislative websites accessed in 2012 and January 2013 to review relevant pharmacy practice laws. DATA SYNTHESIS POC testing for infectious diseases represents a significant opportunity to expand services in community pharmacies. Pharmacist education and training are addressing knowledge deficits in good laboratory practices and test performance and interpretation. Federal regulations do not define the qualifications for those who perform CLIA-waived tests, yet few pharmacists perform such services. Fewer than 20% of states address POC testing in their statutes and regulations governing pharmacy. CONCLUSION POC testing for infectious diseases could benefit patients and society and represents an opportunity to expand pharmacy services in community pharmacies. Existing barriers to the implementation of such services in community pharmacies, including deficits in pharmacist training and education along with state regulatory and legislative variance and vagueness in statutes governing pharmacy, are not insurmountable.