Screening for social determinants of health in community pharmacy: Identifying best practices, barriers, and strategies for success.

The social determinants of health (SDOH) play a key role in patients' access to health care and medications. There exists an area of opportunity to leverage community pharmacists to make a large impact in identifying and incorporating an understanding of a patient's SDOH into their treatment plan. Community pharmacies are accessible and trusted avenues for health care interventions. With the advancement of appointment-based models as well as the increased training of support personnel, community pharmacies may be well suited for this public health task. However, there are major challenges such as paradigm shifts in workflow, reimbursement, and training that must be addressed to make this endeavor successful. This commentary explores the sparse literature related to community pharmacists conducting screening for social risk factors to identify best practices and barriers to implementation and outlines how screening for social needs aligns with the Pharmacists' Patient Care Process.

Atherosclerotic cardiovascular disease risk assessment and predictors of statin use in Filipino-American Women.

WHAT IS KNOWN AND OBJECTIVE: Race and gender disparities in the context of appropriate treatment with lipid-lowering therapies do exist. The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines outlined four groups, three for primary prevention and one for secondary prevention, whom would benefit from statin therapy to target atherosclerotic cardiovascular disease (ASCVD). The application of these recommendations in Filipino women living in the United States is unknown; however, this population is known to have elevated cardiovascular risk. Socio-economic and clinical characteristics that predict statin utilization of this Asian American subgroup need to be explored. METHODS: This was an exploratory analysis of data collected during a cross-sectional study of Filipino-American Women (FAW). The Pooled Cohort equation was used to estimate 10-year ASCVD risk. Bivariate analysis was employed to determine the association between statin treatment and clinical and socio-economic factors. Data were analysed using SAS® 9.4; statistical significance was set at P < 0.05. RESULTS AND DISCUSSION: A total of 384 women (mean age 56.3 years) were included in the original study, and the average 10-year ASCVD risk was 3.5 ± 3.7%. Upon applying the 2013 ACC/AHA guidelines, 97 FAW were categorized into one of the primary prevention groups. Women considered to benefit from a statin based on the guideline criteria but were not prescribed a statin were considered the not statin treated group (n = 55). From the original cohort, 93 FAW reported current statin therapy use and were categorized as statin treated. The clinical characteristics associated with not being statin treated were as follows: untreated blood pressure (P = 0.012), higher diastolic blood pressure (P = 0.015), higher total cholesterol (P < 0.001), higher triglycerides (P = 0.041), higher low-density lipoprotein (P < 0.001) and higher glucose (P = 0.011). The socio-economic factor associated with not being statin treated was having two or more insurance payers (P = 0.005). Overall, this population had a waist circumference and body mass index (BMI) that exceeds guidelines for Asian women (31.5 or 80 cm). WHAT IS NEW AND CONCLUSION: Predictors of statin utilization in FAW are not well documented in the literature. These findings emphasize room for improvement for the prescribing of statins in primary prevention for this study population. Applying culturally appropriate screening strategies to identify cardiovascular risk factors early such as BMI or waist circumference may assist with quantifying patients into one of the statin benefit groups if eligible.

Pharmacovigilance of Sodium-Glucose Cotransporter-2 Inhibitors for Genital Fungal Infections and Urinary Tract Infections: A Review of the Food and Drug Administration Adverse Event Reporting System Database.

Background: Postmarketing surveillance had previously identified the need for revisions in the labeling of the sodium-glucose cotransporter-2 (SGLT2) inhibitors drug class related to the risk of diabetic ketoacidosis. Other adverse events have been reported. Objective: To examine postmarketing surveillance data of the SGLT2 inhibitors, using the Food and Drug Administration Adverse Event Reporting System (FAERS) database, specifically to assess prevalence of urinary tract infections (UTIs) and genital fungal infections. Methods: FAERS case reports submitted between March 2013 and November 2015 were reviewed for 6 SGLT2 inhibitors (mono and combo therapies). The Medical Dictionary for Regulatory Activities (MedDRA) was used to define preferred terms (genital fungal infections: vulvovaginal mycotic infection, vulvovaginal candidiasis, urinary tract infection fungal, and genital candidiasis; UTI: urinary tract infection, genitourinary tract infection, kidney infection, cystitis, and pyelonephritis). Word frequencies were queried using the qualitative data analysis software NVivo 11 (QSR International), and results were then individually reviewed. Results: A total of 12 581 cases were received, but 466 were excluded (total n = 12 115). A total of 348 cases related to genital fungal infections were reported (2.9% of reports submitted): dapagliflozin = 53, empagliflozin/linagliptin = 6, canagliflozin = 267, canagliflozin/metformin = 3, empagliflozin = 17, and dapagliflozin/metformin HCl ER = 2. A total of 727 cases related to UTIs were reported (6% of reports submitted): dapagliflozin = 168, empagliflozin/linagliptin = 5, canagliflozin/metformin = 8, canagliflozin = 503, empagliflozin = 38, and dapagliflozin/metformin HCl ER = 5. Conclusions: A causal relationship between SGLT2 inhibitors and the adverse events reported cannot be established due to the nature of postmarketing surveillance. However, health care providers should counsel patients about these potential adverse events.

Exploring employer job requirements: An analysis of pharmacy job announcements.

OBJECTIVES: Postgraduate training, dual degrees, and board certifications are credentials viewed by academic pharmacy communities and professional organizations as positive assets for those seeking pharmacist jobs; however, a key question merits further investigation: do these views match employer expectations? The primary objective of this study was to identify the most common qualifications employers require as stated in job advertisements. METHODS: Pharmacist job postings from the aggregate jobs website Indeed.com were evaluated for the 20 largest metropolitan areas in the United States. Search criteria included: pharmacist, full-time, and within a 50-mile radius of the metropolitan area. Positions were excluded if they were not pharmacist specific, did not require a pharmacy degree, were part-time, or were temporary. Required and preferred qualifications were collected in the following categories: practice type, experience needed, training, certification, and desired skills. RESULTS: Six hundred and eleven of 1356 postings met inclusion criteria. Positions were classified as community (113), health-system (264), industry (149), academia (9), or other (76). Four hundred and six (66.4%) required a minimum of a Bachelor's of Pharmacy degree, while 174 (28.4%) required a Doctor of Pharmacy degree. Experience was required for 467 positions (range of 6 months to 14 years). Postgraduate training was required for 73 positions (66 residency/7 fellowship). One job required a Master's degree, type unspecified. BPS certifications were required for 7 positions (1.1%) and preferred for 22 positions (3.6%). Certifications and skills most required by employers were verbal and written skills (248), Microsoft Office proficiency (93), immunization certifications (51), and Basic Life Support/Cardiopulmonary Resuscitation certifications (37). CONCLUSION: Postgraduate training, dual degrees, and board certification were not significant factors in the qualification criteria for the positions identified. The qualifications most often required by employers were experience and skills. Our findings indicated that employers wanted many soft skills that cannot be quantified.

Training and retaining community pharmacy leaders: Career pathways after completing a PGY1 community pharmacy residency affiliated with a large supermarket chain.

OBJECTIVE: To determine pharmacist career paths and resident perceptions after completion of a PGY1 community pharmacy residency with a national supermarket pharmacy chain. METHODS: Cross-sectional nationwide survey. RESULTS: Overall, 65% (n = 24) of residents who responded accepted a position with Kroger immediately after graduation. When asked about the degree of value the residency had on obtaining the resident's ideal position, 29 (76%) reported that it was "very valuable" and the remaining 9 (24%) reported that it was "somewhat valuable." Positions that these pharmacists held immediately after residency completion were: clinical pharmacist (clinical coordinators, patient care specialists, or patient care managers; 54%), staff pharmacist (21%), split/mixed (mixed clinical and staffing components; 21%), and pharmacy manager (4%). CONCLUSION: Residency trained pharmacists were retained by the pharmacy chain where they practiced, and the majority of those pharmacists held split or full-time clinical pharmacist roles within the chain supermarket pharmacy.

One size does not fit all: cardiovascular health disparities as a function of ethnicity in Asian-American women.

OBJECTIVE: Although few studies have examined cardiovascular disease in Asian-American subgroups separately, limited data in Asian Americans strongly suggest that some subgroups are at increased risk. The present study examined modifiable cardiovascular risk factor profiles as a function of Asian ethnicity. METHODS: This descriptive cross-sectional pilot study recruited Asian-American women (N=147) in northeast Florida including Cambodians (n=39), Chinese (n=36), Filipinos (n=49), and Vietnamese (n=23). Risk factors included blood pressure, body mass index, waist circumference and blood lipids. RESULTS: Filipino participants (41%) had ≥4 risk factors compared to 21% Cambodian, 13% Vietnamese and 0% Chinese. The Chinese had significantly more participants (44%) with the absence of CVD risk factors compared to all other subgroups. Obesity rate (18%), mean BMI: 26 ± 5 kg/m(2) and mean triglycerides (173 ± 103 mg/dL) were highest in Filipinas (n=49). The Chinese (n=36) had a low rate (4%) of obesity with a mean BMI of 23 ± 3 kg/m(2) and the least risk factors along with the lowest triglycerides (88 ± 44 mg/dL). Cambodians (n=39; BMI of 24 ± 3 kg/m(2)) and Vietnamese (n=23; BMI: 22 ± 3 kg/m(2)) had low rates of obesity with comparable rates of unhealthy lipids and hypertension as the Filipinas. CONCLUSIONS: Modifiable CVD risk factor profiles significantly differed as a function of ethnicity supporting the premise that Asian-American women cannot be categorized as one group and the traditional "one size fits all" prevention or treatment of CVD risk factors should be re-considered.

The prevalence of cardiovascular risk factors and diabetes increases with a body mass index of > or = 23 kg/m2 in Filipino American women.

OBJECTIVE: Although elevated body mass index (BMI) increases the risk for cardiovascular disease (CVD) and diabetes universally, the BMI associated with increased risk for these two diseases needs to be established for Filipino American women (FAW). The relationship of BMI with diabetes and other CVD risk factors in FAW was investigated to determine if BMI levels less than the conventional 25 kg/m2 are associated with increased CVD risk factors. METHODS: In a cross-sectional study conducted in four cities, FAW (n=193), aged 40 to 65 years, were screened for CVD risk factors and diabetes. Mean concentrations and prevalence of CVD risk factors were examined as a function of BMI category (BMI < or =22.9 n=41, BMI 23-24.9 n=46, BMI 25-29.9 n=75, and BMI > or =30 n= 31). RESULTS: Body mass index correlated significantly with waist circumference (P<.0001), systolic blood pressure (P<.0001), diastolic blood pressure (P<.001), fasting blood glucose (P<.05), hemoglobin A1c (P<.001), triglycerides (P<.001), high sensitivity C-reactive protein (P<.001) and high density lipoprotein -C (P<.001). The prevalence of diabetes, decreased levels of high density lipoprotein-cholesterol, hypertension, elevated triglycerides, and high sensitivity C-reactive protein increased significantly (P<.01-.001) with BMI categories starting at BMI 23-24.9 kg/m2. CONCLUSION: Body mass index was an excellent predictor of elevated CVD risk factors in this population and the prevalence of most of these factors increased at BMIs as low as 23-24.9 kg/m2 suggesting a need to investigate risk factors and CVD events as a function of BMI in larger studies of Filipino American women.

Engaging Student Pharmacists in Social Determinants of Health and Health Equity Through Photovoice.

OBJECTIVE: This study aimed to evaluate the impact of an interactive photovoice activity on the perceptions of social determinants of health (SDOH) and health equity among first professional year student pharmacists. METHODS: This study used a mixed-methods exploratory approach at 4 institutions. All students completed a standardized intervention using a prerecorded lecture, active learning using photovoice, and an in-depth debriefing session. The photovoice responses and reflections were analyzed through a deductive approach using content analysis with the applied frameworks of Rolfe's reflection model and the social-ecological model. A presurvey/postsurvey assessed the students' perceptions of SDOH and health equity. Paired sample t tests were conducted to assess the prechange and postchange. RESULTS: A total of 349 students participated; most students reflected at the "what" level (97.7%), whereas 65% reached the "now what" level. Students identified more SDOH factors at the institutional/community level (75.9%) than at the individual/interpersonal level (59.4%) or the society/policy level (28.0%); 191 (55%) students had matchable survey data. A statistically significant improvement was found in the comprehension of health equity concepts (4 items), perceptions of health disparities and system response (4 items), awareness of structural factors impacting equity (3 items), and readiness for inclusivity behavior (3 items). CONCLUSION: A structured teaching and learning activity allowed deeper reflections among student pharmacists. Student perception of the basic terminologies and the impact of beliefs on health care improved after the photovoice assignment. Although students became aware of the SDOH, they had difficulty identifying the structural or upstream factors when addressing SDOH.

Defining the role of pharmacists in addressing the social determinants of health.

As one of the overreaching goals of Healthy People 2030, addressing the social determinants of health (SDOH) to reduce health disparities is a nationwide concern, with objectives informed by interdisciplinary teams of experts. However, there remains much discussion regarding the roles of healthcare providers in addressing SDOH. While current guidance suggests that all members of the healthcare team must be empowered to address SDOH, current guidance explicitly references physicians, nurses, social workers and staff, and do not specifically include pharmacists. While pharmacists are taught about the impact of SDOH in pharmacy curricula, actionable strategies for pharmacists to address SDOH in practice have not been clearly outlined. Pharmacists have multifaceted interactions with patients and may be influential in meeting individual patient needs, identifying social risk factors, and addressing upstream causes of health disparities. This paper proposes a framework for the role of pharmacists in addressing the SDOH through strategies at the patient, practice, and community levels. The concepts presented in this paper are meant to serve as a launch point for discussion and to promote the inclusion of pharmacists in the conversations around sustainable efforts to achieve health equity. This framework is not intended to limit the scope of pharmacists in addressing SDOH - on the contrary, it is our hope that this outline may be used to expand the education of future healthcare professionals regarding their role in addressing the social determinants of health.

An assessment of patient experiences as teachers of cultural sensitivity in an interprofessional setting.

BACKGROUND AND PURPOSE: The importance of cultural sensitivity training in pharmacy education is well-recognized, though best practices are not well described. Traditional teaching approaches such as faculty lectures may result in overgeneralization, lack of nuance, or tokenization. Utilizing patients from diverse special populations as teachers of cultural sensitivity may mitigate these risks. However, faculty must ensure patients feel comfortable, empowered, valuable, and prepared to serve as partners in education. EDUCATIONAL ACTIVITY AND SETTING: Patients were used as teachers of cultural sensitivity in an interprofessional education panel activity at two colleges of pharmacy over two years. Patient experiences with training and preparation for the activity as well as their perceived benefits of partnering in student education were assessed. FINDINGS: Overall, patients reported that training was adequate, and the educational activity provided a sufficient platform for sharing their knowledge with students. Patients felt they provided meaningful contributions to student education, learned valuable information in the process, and formed sincere relationships with each other and faculty. SUMMARY: Faculty at other institutions may wish to adapt this activity to meet the needs of their own institution and empower patients to contribute to the education of health professions students. Practical recommendations are provided for promoting a positive patient experience. A comprehensive training program prepared and empowered patients to teach cultural sensitivity principles to an interprofessional group of health care students.

Impact of a stroke interprofessional simulation on health professional students.

INTRODUCTION: The objective was to describe the interprofessional stroke simulation delivered across three campuses with seven types of health professions students and the impact the activity had on the students. METHODS: An interprofessional stroke simulation event was completed with pharmacy, medical, nursing, physician assistant, occupational therapy, physical therapy, and speech pathology students across a multi-site campus. Pre-activity, demographic information was requested including age, gender, discipline, year in respective program, number of experiences in prior interprofessional events, and comfort working with other health care professionals. The survey was repeated after the session and gathered free-text responses on whether learners gained information on working together, if they learned about the roles of other health care workers, and if they found the session useful. RESULTS: A total of 1820 health care professional students completed the simulation activity over four years. Of those students, 1035 (57%) completed the pre-survey, and 884 (49%) completed the post-survey. From the post-survey results, 91.5% of participants felt that they learned how health care disciplines can work together. Also, 87% of participants felt more comfortable working with learners from other professions. Most participants agreed the session was useful (77.1%) and rated it as moderately to extremely effective (81.8%). CONCLUSIONS: Interprofessional sessions with health care professional students are beneficial for learning new information about other professions and enhancing comfort levels in working with interprofessional groups. The interprofessional simulation improved the comfort level of students working with other health care professional students and should be considered in professional student curricula.

Strategies for Incorporating Health Disparities and Cultural Competency Training into the Pharmacy Curriculum and Co-curriculum.

Objective. To identify and review strategies reported in the literature for strengthening instruction about both health disparities and cultural competency (HDCC) within various portions of the Doctor of Pharmacy curriculum and co-curriculum.Findings. The classroom strategies reported in the literature for incorporating HDCC into the PharmD curriculum involved teaching a single course or series of courses in HDCC. Activities found to be effective in teaching HDCC were those that involved case-based and community engagement exercises. Recommendations for incorporating HDCC into the experiential education included preceptor development in areas of HDCC to assess student understanding of health disparities concepts, increasing student engagement with diverse patient populations, and implementation of cross-cultural communication models at clinical sites. Co-curricular and interprofessional (IPE) portions of pharmacy training were found to permit greater methodological flexibility for incorporating training in HDCC, as they often confronted fewer time or space constraints than classroom endeavors. Documented methods for teaching HDCC within co-curricular and IPE experiences included service learning, study abroad, symposia, and forums.Summary. There is a paucity of literature describing processes for incorporation of health disparities and cultural competency education and training into the PharmD program. Findings suggest that conceptual frameworks for HDCC should be used throughout the pharmacy curriculum, with learning activities mapped to relevant pharmacy education standards to ensure coverage of important practice competencies. Best practices also involve the use of contemporary tools, strategies, and resources from a cross-section of disciplines that provide opportunities for learners to correct misconceptions and biases through active situational problem-solving.

Engaging in Authentic Allyship as Part of Our Professional Development.

Educational institutions increasingly recognize the importance of diversity, equity, and inclusion (DEI) efforts to combat and dismantle structures that sustain inequities. However, successful DEI work hinges on individuals being authentic allies and incorporating allyship into their professional development. Allyship involves members of dominant groups recognizing their privilege and engaging in actions to create inclusivity and equitable spaces for all. Individuals from dominant groups with desires to actively support others from marginalized groups are often unsure how to fight oppression and prejudice. Our goal as faculty with diverse perspectives and heterogeneous intersectional identities is to provide readers with the tools to develop as an authentic ally through educating themselves about the identities and experiences of others, challenging their own discomfort and prejudices, dedicating the time and patience to learning how to be an ally, and taking action to promote change toward personal, institutional, and societal justice and equality. Ultimately, each person must advocate for change because we all hold the responsibility. When everyone is an authentic ally, we all thrive and rise together.

Correlation Between Pharmacy Students' Implicit Bias Scores, Explicit Bias Scores, and Responses to Clinical Cases.

Objective. The purpose of this study was to identify the extent of implicit and explicit bias in a sample of pharmacy students and to determine whether there is an association between implicit bias, explicit bias, and responses to clinical cases.Methods. Investigators sent links to two online surveys to students at six US schools and colleges of pharmacy. In the first survey, students responded to two clinical cases. Students were presented with a picture of a White or Black patient with each clinical case. On the second survey, students indicated their level of racial implicit bias as assessed by the Harvard Implicit Association Test and their level of racial explicit bias. Pearson's correlation was used to determine the correlation between bias and responses to the clinical cases.Results. Three hundred fifty-seven first, second, and third year pharmacy students responded to both surveys (response rate 52%). The students who were presented with the picture of a Black patient rated the patient's pain and the reliability of the patient's family as higher than students presented with the picture of a White patient. Students had more negative implicit and explicit bias towards Black patients. Neither implicit nor explicit bias correlated with student responses to the clinical cases.Conclusion. Evidence of slight to moderate negative implicit bias and slight negative explicit bias towards Black patients was identified in this group of pharmacy students. Future studies that include a more representative population and heighten the stakes of the clinical scenario should be done to investigate a possible correlation between bias and clinical behaviors.

Incorporation of a mock pharmacy and therapeutics committee as an entrustable professional activity supporting task.

INTRODUCTION: Entrustable professional activities (EPAs) denote activities and tasks students should be able to perform by graduation irrespective of their practice setting. Formulary decision-making includes several core EPA related skills, such as utilization of drug information, written, and verbal skills. The objective of this study was to describe an EPA supporting task aimed at improving utilization of evidence-based medicine skills and its impact on student self-perceived confidence, rating of skills needed, and competence. METHODS: Teams comprised of six to seven students were assigned a drug and instructed to complete the following activities: (1) background literature search, (2) drug monograph, (3) five-min presentation to simulate a live pharmacy and therapeutics (P&T) committee meeting, and (4) vote on a formulary drug in each drug class. Students completed a pre/post five-point Likert scale self-efficacy survey and a perceived importance survey. A scoring rubric assessed monograph and presentation elements (max points 30). Survey items were analyzed using Wilcoxon signed-rank test. Descriptive statistics were used for assignment grades. RESULTS: One hundred ninety students completed the pre/post self-efficacy and perceived importance survey. Confidence showed statistically significant improvement (P < .001) in nine target skill areas. In ranking importance, all 12 assessed skills exhibited a statistically significant increase following the activity. CONCLUSIONS: A mock P&T activity represents an innovative way to evaluate an EPA supporting task that allows students to improve their evidence-based analysis, written, and verbal communication skills.

Development of a State-Wide IPE Faculty Toolkit.

Developing effective interprofessional education (IPE) training activities can be challenging, and faculty at individual programs and schools often take on this task independently. In doing so, similar ideas are frequently recreated for implementation at multiple institutions, and considerable time may be spent in these duplicative efforts. This paper describes a new state-wide effort in Tennessee to compile classroom-based IPE curricular resources and activities being used across the state in order to reduce redundancy, increase efficiency and effectiveness, and ultimately improve training outcomes for students entering health-related professions. We focus on processes involved in developing this contribution to IPE education in order to emphasize feasibility and encourage similar initiatives in other regions.

Factors associated with medication nonadherence among Medicare low-income subsidy beneficiaries with diabetes, hypertension, and/or heart failure.

BACKGROUND: Previous studies have documented factors influencing medication nonadherence among the Medicare population, but few studies have examined medication nonadherence among the Medicare low-income subsidy (LIS) population. Furthermore, little is known about the factors associated with nonadherence among this population, especially those with prevalent chronic conditions such as type 2 diabetes, hypertension, or heart failure. OBJECTIVE: To examine factors associated with the likelihood of medication nonadherence among Medicare LIS recipients with type 2 diabetes, hypertension, or heart failure. METHODS: This was a retrospective analysis of 2012-2013 Medicare Parts A, B, and D claims (most recent available for this research) linked to the Area Health Resources Files. Beneficiaries aged 65 years or older with continuous Medicare coverage and receiving any LIS were included. Individuals were categorized into full LIS or partial LIS groups. Nonadherence was determined by the proportion of days covered less than 80% for specified oral type 2 diabetes, hypertension, and heart failure medications, as defined by the Pharmacy Quality Alliance. A multivariate logistic regression was used to determine and compare individual-level and community-level characteristics associated with nonadherence among the entire study sample, the full LIS group, and the partial LIS group. RESULTS: The study sample included 505,771 Medicare beneficiaries, with 448,509 (88.7%) receiving full LIS and 57,262 (11.3%) receiving partial LIS. The proportion of individuals nonadherent was higher among the full LIS population (33.2%) than that of the partial LIS population (30.8%). Among the entire population, younger age was associated with nonadherence (OR = 0.98; 95% CI = 0.98-0.99). Men were more likely to be nonadherent than women (OR = 1.12; 95% CI = 1.11-1.14). Compared with non-Hispanic Whites, racial/ethnic minorities had higher nonadherence. Compared with beneficiaries who were non-Hispanic White, the ORs for those who were Black, Hispanic, Asian, and other were 1.41 (95% CI = 1.38-1.43), 1.58 (95% CI = 1.55-1.61), 1.08 (95% CI = 1.05-1.11), and 1.63 (95% CI = 1.56-1.70), respectively. There were higher nonadherence rates among patients living in communities with lower socioeconomic characteristics, such as a metropolitan statistical area (MSA vs non-MSA; OR = 1.05, 95% CI = 1.04-1.07). A higher risk adjustment summary score, indicating worse health status, was associated with an increased likelihood of medication nonadherence (OR = 1.21; 95% CI = 1.20-1.22). These patterns were similar among the full and partial LIS groups. CONCLUSIONS: Individual- and community-level characteristics were associated with the likelihood of medication nonadherence among Medicare LIS recipients with type 2 diabetes, hypertension, or heart failure. These characteristics included younger age, male sex, racial/ethnic minorities, living in lower socioeconomic communities, and a higher risk adjustment summary score. This study provided insight into medication nonadherence within the Medicare LIS population and identified the need to consider these factors when developing future policies to improve medication adherence. DISCLOSURES: This study was funded by the Pharmaceutical Research & Manufacturers of America (PhRMA), which was involved in the preparation and revision of the manuscript. Dougherty is employed by PhRMA. Todor was a PQA-CVS Health Foundation Scholar who was funded to work on this study. Hines is employed by Pharmacy Quality Alliance. Wang reports grants from AbbVie, Curo, Bristol Myers Squibb, and Pfizer, during the time of this study, and fees from the PhRMA Foundation for work on its Heath Outcomes Research Advisor Committee. The other authors have nothing to disclose. This study was presented as a poster at the online 2020 PQA Annual Meeting, May 7, 2020.

Inclusion of Health Disparities, Cultural Competence, and Health Literacy Content in US and Canadian Pharmacy Curriculums.

Objective. To determine how US and Canadian pharmacy schools include content related to health disparities and cultural competence and health literacy in curriculum as well as to review assessment practices.Methods. A cross-sectional survey was distributed to 143 accredited and candidate-status pharmacy programs in the United States and 10 in Canada in three phases. Statistical analysis was performed to assess inter-institutional variability and relationships between institutional characteristics and survey results.Results. After stratification by institutional characteristics, no significant differences were found between the 72 (50%) responding institutions in the United States and the eight (80%) in Canada. A core group of faculty typically taught health disparities and cultural competence content and/or health literacy. Health disparities and cultural competence was primarily taught in multiple courses across multiple years in the pre-APPE curriculum. While health literacy was primarily taught in multiple courses in one year in the pre-APPE curriculum in Canada (75.0%), delivery of health literacy was more varied in the United States, including in a single course (20.0%), multiple courses in one year (17.1%), and multiple courses in multiple years (48.6%). Health disparities and cultural competence and health literacy was mostly taught at the introduction or reinforcement level. Active-learning approaches were mostly used in the United States, whereas in Canada active learning was more frequently used in teaching health literacy (62.5%) than health disparities and cultural competence (37.5%). Few institutions reported providing professional preceptor development.Conclusion. The majority of responding pharmacy schools in the United States and Canada include content on health disparities and cultural competence content and health literacy to varying degrees; however, less is required and implemented within experiential programs and the co-curriculum. Opportunities remain to expand and apply information on health disparities and cultural competence content and health literacy content, particularly outside the didactic curriculum, as well as to identify barriers for integration.

Saxagliptin: a new dipeptidyl peptidase 4 inhibitor for type 2 diabetes.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of saxagliptin, a new dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of type 2 diabetes. DATA SOURCES: Searches of PubMed (1966-March 2010) and International Pharmacy Abstracts (1970-March 2010) were conducted using the key words saxagliptin, Onglyza, and BMS-477118. A review of bibliographies of retrieved articles was also performed to identify additional references. STUDY SELECTION AND DATA EXTRACTION: All identified studies published in English and involving efficacy and safety of saxagliptin in the treatment of type 2 diabetes were reviewed. DATA SYNTHESIS: Saxagliptin is a competitive inhibitor of DPP-4 that slows the degradation of incretin hormones, thereby stimulating insulin secretion, reducing postprandial glucagon, and decreasing glucose levels. Saxagliptin is well absorbed after oral administration and demonstrates a pharmacokinetic profile that is compatible with once-daily dosing. Clinical trials with saxagliptin monotherapy for the treatment of type 2 diabetes showed a reduction in hemoglobin A(1c) (A1C) of 0.43-0.9%. Saxagliptin has demonstrated similar reductions in A1C when used as add-on therapy with metformin, sulfonylureas, and thiazolidinediones. The combination of saxagliptin and metformin for initial therapy in treatment-naïve patients was associated with greater improvements in A1C than either agent alone. In general, saxagliptin therapy is well tolerated. The most common adverse effects occurring in clinical trials were headache, nasopharyngitis, upper respiratory tract infections, and urinary tract infections. CONCLUSIONS: Saxagliptin is effective as monotherapy or add-on therapy for the management of type 2 diabetes. Because saxagliptin has a higher cost and reduces A1C and other surrogate markers of glucose control to a lesser extent than other well-validated therapies, such as metformin, saxagliptin should be reserved for patients who fail or are intolerant of conventional treatments for type 2 diabetes.