Bone health screening, education, and referral project in northwest Iowa: creating a model for community pharmacies.

OBJECTIVE: To identify women 60 years of age or older at risk for osteoporosis, provide education, and refer at-risk women to physicians through a community pharmacy screening program and to develop a model in community pharmacies for this service. DESIGN: Cross-sectional study. SETTING: Northwest Iowa between August 2005 and October 2005. PARTICIPANTS: 159 women 60 years of age or older screened at five pharmacies. INTERVENTIONS: Five pharmacies completed education on osteoporosis, received training on use of the Achilles InSight by GE Lunar, and screened women 60 years of age or older for osteoporosis. Patients received education on osteoporosis and risk factors during the screening and were stratified as low, moderate, or high risk based on a T-score. Patients at risk were referred to their physician for further evaluation. Pharmacists telephoned patients at 3 and 6 months after screening to determine self-initiated or provider-initiated changes in their treatment plan. MAIN OUTCOME MEASURES: Descriptive population characteristics, proportion of participants with medical risk factors for osteoporosis, proportion of patients screened at risk, and proportion of physician or patient self-initiated changes instituted as a result of the screening. RESULTS: Of the 159 women screened, 53% were rated as moderate or severe risk and referred to their physicians. Three- and 6-month follow-up results revealed a high proportion of self-initiated lifestyle or medication changes and a small proportion of physician-initiated changes. CONCLUSION: The majority of women 60 years of age or older who attended a community pharmacy osteoporosis screening were at moderate or high risk for osteoporosis. A fee-for-service model was created for community pharmacists to improve recognition and treatment of patients at risk. A toolkit will be created for pharmacists to promote their role in improving the bone health of older patients.

Real world clinical outcomes and patient characteristics for canagliflozin treated patients in a specialty diabetes clinic.

OBJECTIVE: To examine characteristics and outcomes of type 2 diabetes (T2DM) patients prescribed canagliflozin (CANA) and managed in the real-world setting of a diabetes clinic. Primary outcome was change in A1c, and secondary outcomes were change in weight and blood pressure. METHODS: Study was an electronic health record (EHR) review of CANA prescribed at the diabetes clinic from June 2013 to June 2015. Patients were included in the study if they were adults with T2DM, received routine follow-up diabetes care at the diabetes clinic, received an initial prescription for CANA from a diabetes clinic prescriber, and returned for at least one follow-up office visit (OV) after initial CANA prescribing. Paired t-tests were performed on the primary and secondary outcomes, and p < .05 was considered statistically significant. Descriptive statistics were used to characterize the population and other outcomes. RESULTS: A total of 462 patients met study inclusion criteria. Mean baseline values were: age 55.32 years, BMI 38.23 kg/m2, A1c 8.84%, mean number of diabetes medications (including CANA) 3.58. Men comprised 60% of patients. At baseline, 54% of patients were prescribed insulin. A1c decreased by 1.06% and 1.09% (p < .0001), weight decreased by 2.01% and 1.83% (p < .001), systolic blood pressure (SBP) decreased by 3.2% and 2.4% (p < .0001), and diastolic blood pressure (DBP) decreased by 2.59% and 2.16% (p = .0002) from baseline to first and second follow-up OV, respectively. Study limitations included retrospective design, inability to control for confounding factors (e.g. changes in nutrition, exercise, medical care plan, medications), missing information in the EHR, potential lack of generalizability of results to those in a non-specialty diabetes clinic, inability to assess adherence, and inability to assess reliable adverse event data. CONCLUSIONS: ANA was associated with a statistically and clinically significant reduction in A1c, weight, and blood pressure when added to multiple diabetes medication regimens by prescribers in a diabetes clinic.

Real-world Clinical Outcomes Among Patients With Type 2 Diabetes Receiving Canagliflozin at a Specialty Diabetes Clinic: Subgroup Analysis by Baseline HbA1c and Age.

PURPOSE: Canagliflozin, a sodium glucose co-transporter 2 inhibitor developed for the treatment of type 2 diabetes mellitus (T2DM), has demonstrated effectiveness in patients with T2DM receiving care at a specialty diabetes clinic. We report the outcomes in these patients in subgroups classified by baseline hemoglobin A1c (HbA1c) and age. METHODS: This subgroup analysis was based on a review of data from the electronic health records of adults with T2DM who were prescribed canagliflozin at a specialty diabetes clinic and who returned for ≥1 follow-up office visit. Mean changes from baseline to the first and second follow-up office visits in HbA1c, body weight, and systolic and diastolic blood pressure (BP) were calculated in each subgroup classified by baseline HbA1c (≥7.0%, ≥8.0%, and >9.0%) and age (<65 and ≥65 years). FINDINGS: Of the 462 patients included in the study, 430, 305, and 169 patients had baseline HbA1c ≥7.0%, ≥8.0%, and >9.0%, respectively; 396 and 66 patients were aged <65 and ≥65 years, respectively. With canagliflozin use, patients across subgroups classified by baseline HbA1c and age experienced clinically and statistically significant reductions from baseline in HbA1c, body weight, and systolic BP that were sustained over 2 office visits; diastolic BP was also reduced across baseline HbA1c and age subgroups. Greater reductions in HbA1c were seen among the canagliflozin-treated patients with higher baseline HbA1c and among younger versus older patients. IMPLICATION: These findings from clinical practice demonstrate real-world effectiveness of canagliflozin in lowering HbA1c, body weight, and systolic BP among patients with T2DM, regardless of baseline HbA1c levels or age.

A multiyear analysis of team-based learning in a pharmacotherapeutics course.

OBJECTIVES: To evaluate the impact of team-based learning (TBL) in a pharmacotherapeutics course on pharmacy students' ratings of faculty instructors and the course, and to assess students' performance after implementation of team-taught TBL. DESIGN: Teaching methodology in a pharmacotherapeutics course was changed from a lecture with recitation approach in 2 semesters of a 6 credit-hour course to a TBL framework in a 3-semester 3+4+5 credit hour course. The distribution of faculty of instruction was changed from 4 faculty members per week to 1 faculty per 1-credit-hour module. TBL consisted of preclass study preparation, readiness assurance (Individual Readiness Assessment Test and Group Readiness Assessment Test), and in-class application exercises requiring simultaneous team responses. ASSESSMENT: Retrospective analysis of student ratings of faculty and instructional methods was conducted for the 2 years pre-TBL and 4 years during TBL. Final course grades were evaluated during the same time period. Student ratings showed progressive improvements over 4 years after the introduction of team-based learning. When aggregated, ratings in the "excellent teacher" category were unchanged with TBL compared to pre-TBL. Improvements in faculty instructor approaches to teaching were noted during TBL. Group grades were consistently higher than individual grades, and aggregate course grades were similar to those prior to TBL implementation. CONCLUSION: Implementation of TBL in a pharmacotherapeutics course series demonstrated the value of team performance over individual performance, indicated positive student perceptions of teaching approaches by course faculty, and resulted in comparable student performance in final course grades compared to the previous teaching method.

Diabetes care practice patterns of recent pharmacy graduates.

PURPOSE: The objective of this project was to determine the amount and type of clinical skills and diabetes education provided by recent pharmacy school graduates. METHODS: Six hundred and one graduates were e-mailed a link to an online survey. Subjects were asked to report how frequently they either educate patients on diabetes self-care activities or perform diabetes-related patient care skills and to rate their ability to do so as poor, fair, good, or excellent. RESULTS: Data from 155 (25.8%) respondents were analyzed. The most commonly reported clinical activity was changing medication, followed by interpreting blood glucose patterns, medication management therapy, and interpreting laboratory results. Subjects reported educating patients more on the signs and symptoms of hypoglycemia, blood glucose monitoring, and diet information relative to other topics. The majority of subjects rated their skills as good or excellent. CONCLUSION: Pharmacists reported the most commonly performed diabetes-related clinical skill was changing medication and they most often educate patients about hypoglycemia and blood glucose monitoring. Subjects, who rated themselves poor/fair in these skills, preferred active learning strategies to enhance their ability.

The impact of diabetes concentration programs on pharmacy graduates' provision of diabetes care services.

OBJECTIVE: To determine practice outcomes associated with doctor of pharmacy (PharmD) graduates from 2 universities who completed a diabetes-concentration. METHODS: An online survey instrument was sent to 93 PharmD graduates who completed a concentration in diabetes and 94 control graduates to determine their knowledge of and skills in providing diabetes care and how frequently they provided diabetes care services. RESULTS: Ninety-seven graduates (52%) responded. Significantly more graduates with a diabetes concentration rated their ability to instruct patients on insulin administration, blood glucose monitoring, foot care, and insulin dose adjustment as good or excellent compared to a control group of graduates. Graduates with a diabetes concentration also rated their ability to perform blood glucose monitoring and foot examinations higher than graduates without a diabetes concentration (P < 0.05). CONCLUSION: Completing a diabetes concentration increased graduates' knowledge of diabetes and confidence in their ability to provide care but did not appear to alter their practice patterns significantly. Further study is needed to determine whether other barriers to pharmacists providing diabetes care exist in practice settings.

A diabetes camp as the service-learning capstone experience in a diabetes concentration.

OBJECTIVES: To assess the effectiveness of a service-learning advanced pharmacy practice experience (APPE) in a diabetes camp to improve student confidence in diabetes knowledge and related skills DESIGN: Pharmacy students assisted medical staff during a week-long diabetes camp for children. Students participated in all aspects of diabetes care, as well as wrote pre- and post-camp reflection papers, completed online quizzes, presented an educational training session, and completed pre- and post-camp survey instruments. ASSESSMENT: Students' confidence in their diabetes knowledge and patient care skills increased as a result of participating in the camp. CONCLUSION: A diabetes camp APPE improved students' confidence in their knowledge and ability to manage diabetes, and allowed them to gain experience working with an interdisciplinary team in a unique real-world environment.