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1.
Healthcare (Basel) ; 12(17)2024 Aug 27.
Article in English | MEDLINE | ID: mdl-39273733

ABSTRACT

Shared decision-making (SDM) is an essential component of patient-centered healthcare and disease management. However, the association of SDM with healthcare resource utilization and patient-reported outcomes among multimorbid individuals is not well understood. This study sought to evaluate the association of SDM with healthcare resource utilization and patient-reported outcomes among United States (US) adults with multimorbidity. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS) for this cross-sectional study. Eligible participants were US adults with two or more comorbidities. The predictor variable was SDM (optimal versus not optimal). The outcome variables were healthcare resource utilization and patient-reported outcomes. Logistic regression models, adjusted for demographic characteristics, assessed associations with SDM for each healthcare resource utilization and patient-reported outcome variable. The analysis maintained the complex survey data and was weighted to produce nationally representative estimates. Individuals who reported optimal SDM in adjusted analyses utilized more healthcare resources compared to those who reported not optimal SDM. Individuals with optimal SDM had more than one outpatient visit (odds ratio OR = 1.23, 95% CI = 1.03-1.47), emergency room visit (OR = 1.55, 95% CI = 1.17-2.06), and inpatient discharge (OR = 1.44, 95% CI = 1.05-1.96). Additionally, these individuals had higher odds of reporting limitations in their ability to work or engage in other activities due to their physical health in the past four weeks (OR = 1.27, 95% CI = 1.01-1.60). This study indicated evidence of increased healthcare resource utilization among patients who participate in SDM with their providers, which should be explored in future studies.

2.
JMIR Cancer ; 9: e37330, 2023 Apr 28.
Article in English | MEDLINE | ID: mdl-37115587

ABSTRACT

BACKGROUND: Cancer is increasingly being treated as a chronic disease rather than an acute one-time illness. Additionally, oral anticancer therapies, as opposed to intravenous chemotherapy, are now available for an increasing number of cancer indications. Mobile health (mHealth) apps for use on mobile devices (eg, smartphones or tablets) are designed to help patients with medication adherence, symptom tracking, and disease management. Several previous literature reviews have been conducted regarding mHealth apps for cancer. However, these studies did not address patient preferences for the features of cancer mHealth apps. OBJECTIVE: The primary aim was to review the scientific literature that describes the features and functions of mHealth apps designed for cancer self-management. METHODS: As the purpose of this review was to explore the depth and breadth of research on mHealth app features for cancer self-management, a scoping review methodology was adopted. Four databases were used for this review: PubMed/MEDLINE, Embase, CINAHL, and PsycINFO. Citation and reference searches were conducted for manuscripts meeting the inclusion criteria. A gray literature search was also conducted. Data extracted from manuscripts included author, title, publication date, study type, sampling type, cancer type, treatment, age of participants, features, availability (free or subscription), design input, and patient preferences. Finally, the features listed for each app were compared, highlighting similarities across platforms as well as features unique to each app. RESULTS: After the removal of duplicates, 522 manuscripts remained for the title and abstract review, with 51 undergoing full-text review. A total of 7 manuscripts (referred to as studies hereafter) were included in the final scoping review. App features described in each study varied from 2 to 11, with a median of 4 features per app. The most reported feature was a symptom or side effect tracker, which was reported in 6 studies. Two apps specified the inclusion of patients and health care providers during the design, while 1 app noted that IT and communications experts provided design input. The utility of the apps for end users was measured in several ways, including acceptability (measuring the end users' experience), usability (assessing the functionality and performance by observing real users completing tasks), or qualitative data (reports from end users collected from interviews or focus groups). CONCLUSIONS: This review explored the literature on cancer mHealth apps. Popular features within these mHealth apps include symptom trackers, cancer education, and medication trackers. However, these apps and features are often developed with little input from patients. Additionally, there is little information regarding patient preferences for the features of existing apps. While the number of cancer-related apps available for download continues to increase, further exploration of patient preferences for app features could result in apps that better meet patient disease self-management needs.

3.
J Opioid Manag ; 18(2): 95-105, 2022.
Article in English | MEDLINE | ID: mdl-35476879

ABSTRACT

OBJECTIVE: To identify the strongest predictors of opioid use among older United States' (US) adults (≥50 years) with pain. DESIGN: Cross-sectional retrospective database design. SETTING: 2017 Medical Expenditure Panel Survey data. PARTICIPANTS: Civilian, noninstitutionalized sample of US adults aged ≥50 years alive for the calendar year with pain in the past 4 weeks. INTERVENTIONS: Hierarchical logistic regression models assessed significant predictors of opioid use, which included: predisposing, enabling, need, personal health practices, and external environmental factors. MAIN OUTCOME MEASURES: Opioid use status (opioid user vs. nonopioid user). RESULTS: Among 51,372,861 civilian, noninstitutionalized US adults alive aged ≥50 years with pain in 2017, the opioid use prevalence was 27.4 percent (95 percent confidence interval = 25.8-29.0). Predictors of opioid use included: white versus other race (adjusted odds ratio, AOR = 1.430), Hispanic versus non-Hispanic ethnicity (AOR = 0.648), up to high school versus higher than high school education (AOR = 1.259), functional limitation versus no limitation (AOR = 1.580), lit-tle/moderate versus quite a bit/extreme pain (AOR = 0.422), good versus fair/poor perceived mental health status (AOR = 1.429), smokers versus nonsmokers (AOR = 1.523), and residing in the northeast versus west US (AOR = 0.646). CONCLUSIONS: This study of 51 million older US adults with pain indicated that several factors including race, ethnicity, education, functional limitations, pain severity, mental health status, smoking status, and region of the country were pre-dictors of opioid use. Future research is needed in additional clinical populations and to investigate where these findings diverge from previous studies.


Subject(s)
Analgesics, Opioid , Opioid-Related Disorders , Adult , Aged , Analgesics, Opioid/therapeutic use , Cross-Sectional Studies , Humans , Middle Aged , Opioid-Related Disorders/diagnosis , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pain/diagnosis , Pain/drug therapy , Pain/epidemiology , Retrospective Studies , United States/epidemiology
4.
BMJ Open ; 12(1): e049727, 2022 Jan 24.
Article in English | MEDLINE | ID: mdl-35074808

ABSTRACT

OBJECTIVES: This study aimed to determine if differences exist in healthcare expenditures of older United States (US) adults with pain based on self-reported mental health status, which is important to know given the prevalence of pain and poor mental health in the USA. DESIGN: This was a cross-sectional study. SETTING: US Medical Expenditure Panel Survey (MEPS) interviews. PARTICIPANTS: US adults aged ≥50 years, with self-reported pain in the past 4 weeks and positive healthcare expenditure in the 2018 Medical Expenditure Panel Survey (MEPS). The independent variable was poor versus good mental health status. PRIMARY AND SECONDARY OUTCOME MEASURES: Descriptive statistics compared demographic characteristics (using chi-square tests) and mean healthcare expenditures (using t-tests) between groups. Adjusted linear regression models with logarithmically-transformed expenditures compared differences in: total; inpatient; outpatient; emergency room; office-based; prescription medications and other expenditures. Analyses accounted for the complex MEPS design and were weighted to produce nationally-representative results. The a priori alpha level was 0.05. RESULTS: The weighted population included 57 134 711 older US adults with self-reported pain (14.4% poor mental health, 85.6% good mental health). Compared with individuals with good mental health, individuals with poor mental health had higher unadjusted total expenditures (US$20 231 vs US$13 379, p<0.0001), higher prescription medication expenditures (US$5924 vs US$3610, p<0.0001) and higher other expenditures (US$4833 vs US$2285, p<0.0001). In adjusted multivariable linear regression models, there were no differences in expenditures between those with poor mental health and those with good mental health status. CONCLUSIONS: There were no statistically significant differences in adjusted annual (2018) positive healthcare expenditures among older US adults with pain and poor versus good mental health status.


Subject(s)
Delivery of Health Care , Health Expenditures , Adult , Aged , Cross-Sectional Studies , Health Status , Humans , Middle Aged , Pain , United States/epidemiology
5.
J Pharm Pract ; 35(5): 691-700, 2022 Oct.
Article in English | MEDLINE | ID: mdl-33759609

ABSTRACT

BACKGROUND: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. OBJECTIVE: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. METHODS: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). RESULTS: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. CONCLUSION: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.


Subject(s)
Diabetes Mellitus , Hypertension , Humans , Medication Therapy Management , Program Evaluation , Rural Population , United States , Urban Population
6.
Healthcare (Basel) ; 9(10)2021 Oct 05.
Article in English | MEDLINE | ID: mdl-34683007

ABSTRACT

The objective of this study was to assess the pattern of healthcare expenditures among United States (U.S.) adults aged ≥50 years with pain and annual total positive healthcare expenditures with different levels of perceived health. The study used the 2018 Medical Expenditure Panel Survey data. Unadjusted and adjusted linear regression models were used to compare logarithmically transformed total healthcare expenditures between those with excellent, very good, good, and fair/poor health. The a priori alpha value was 0.05. The study included 5123 U.S. adults aged ≥50 with self-reported pain (excellent = 8.9%, very good = 28.3%, good = 36.2%, fair/poor = 26.6%). In adjusted analyses, compared to fair/poor health, those with excellent health had the greatest adjusted reduction in expenditures (55% lower), followed by very good health (36.5% lower) and good health (24.9% lower). In conclusion, total positive healthcare expenditures were comparatively lower among those with better perceived health status for older (≥50 years) U.S. adults with pain that interfered with normal work in the past four weeks.

7.
Pharmacy (Basel) ; 9(4)2021 Oct 15.
Article in English | MEDLINE | ID: mdl-34698288

ABSTRACT

Validation studies of pain interference instruments used among student pharmacists are rare yet essential for understanding their appropriate use and interpretation in pharmacy education and practice. This study conducted validation and reliability assessments of a five-item Pain Interference Scale previously administered to student pharmacists. Construct validity was assessed using Rasch analysis. Unidimensionality was measured using: point-biserial measure correlations; percent of raw variance explained by items; difference between expected; variance modeled by items; and Rasch model fit. To assess scale functioning, response frequency distribution, observed average and sample expected logit distribution, Andrich logit distribution, item separation, and item reliability were assessed. Visual examination of the Item-Person Map determined content validity. Items explained 64.2% of data raw variance. The difference between raw variance modeled and observed was 0.6. Point-biserial measure correlations were >0.77. Item mean-square infits were 0.7-1.3 while outfit measures were 0.72-1.16. There were >10 responses per response category, response frequency and Andrich thresholds progressively advanced, and observed average and sample expected logits advanced monotonically, Andrich logits = -2.33-1.69, item separation = 2.61, and item reliability = 0.87. Item probability curves indicated response categories were minimally yet adequately distinct. Cronbach's alpha = 0.93. The Item-Person Map had a ceiling effect indicating content gaps. In conclusion, the pain interference instrument has acceptable construct validity yet contains content gaps. Additional difficult items should be added to the instrument to better capture pain interference among student pharmacists.

8.
Prev Med Rep ; 17: 101038, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31956473

ABSTRACT

Medication therapy management (MTM) services, including targeted, pharmacist-delivered, tertiary prevention interventions, were provided to rural patients with chronic diseases via an academic-community partnership. The purpose of this investigation was to evaluate the overall program and pre/post patient outcomes from this four-year, multi-site collaboration. Five community health sites collaborated with a university-based MTM provider to deliver services in Arizona (2012-16). Eligible patients: were 18 or older (median 65 years); had a diagnosis of diabetes and/or hypertension; and resided in a rural community. Participants received an initial telephone consultation with the MTM pharmacist; follow-up consultations were conducted after 30 or 90 days for high- and low-risk patients, respectively. Community partner staff collected clinical data and addressed pharmacists' recommendations. Descriptive analysis and bivariate analyses of pre- and post-intervention results were conducted. Most (n = 410, 70%) of the 577 participants receiving an initial and follow-up consultation with the MTM pharmacist had both diabetes and hypertension. These individuals showed statistically significant improvements in fasting blood glucose (p < 0.0001), hemoglobin A1C (p = 0.0082) and systolic blood pressure (p = 0.009) while those with only one condition did not demonstrate significant changes. While the pre/post changes in chronic disease control indicators were statistically significant, the clinical significance was low to moderate. Patients with both comorbid diabetes and hypertension experienced benefit from collaborative, targeted MTM pharmacist-delivered, tertiary prevention interventions in tandem with community-based pharmacy resources. This multi-site MTM program showed promise in increasing patients' use of these services, yet effective strategies are needed to expand recruitment of eligible patients in the future.

9.
J Am Pharm Assoc (2003) ; 60(3): 475-480.e1, 2020.
Article in English | MEDLINE | ID: mdl-31917249

ABSTRACT

OBJECTIVE: To qualitatively assess community health workers' (CHWs') perceptions of the challenges and benefits associated with participating in a collaborative, interprofessional medication therapy management (MTM) program for rural, underserved, predominantly Latinx, patients with diabetes and hypertension. METHODS: Nine CHWs participated in a 1-hour, semistructured focus group that explored their experiences while assisting in the delivery of MTM services through an academic community partnership between an MTM provider and participating rural clinics. Audio recordings of the focus group were transcribed and thematically analyzed by 2 independent reviewers. RESULTS: All program-involved CHWs participated in the focus group. Qualitative analysis identified 2 overarching themes: (1) opportunities and (2) challenges. Opportunities were further subcategorized as benefits to (1) CHWs, (2) patients, or (3) academic community MTM research. The CHWs perceived that they served as a liaison among the medical provider (prescriber), patient, and MTM pharmacist. Benefits to the patients focused on the integration of CHWs as essential to patient recruitment, especially for those who were reluctant to participate or receive a phone call from a stranger. The major challenges identified were (1) interruptions in workflow and (2) communication between CHWs and the health care practitioners (physicians, nurse practitioners, pharmacists). Specifically, the CHWs universally agreed that they needed more time after receiving patient report, scheduling a visit with the patient, and communicating with the patient's health care provider to better understand the individual's circumstances and needs. CONCLUSION: This study identified perceived opportunities and challenges faced by CHWs and chronically ill, rural Latinx patients in the acceptance of MTM program. These findings may be useful for all interprofessional health care team members to better understand and appreciate the role of CHWs, while simultaneously enhancing and improving respective medication adherence efforts, and to improve collaborative, academic community programs in the future.


Subject(s)
Community Health Workers , Hypertension , Medication Therapy Management , Humans , Patient Care Team , Pharmacists , Qualitative Research
10.
J Manag Care Spec Pharm ; 25(12): 1334-1339, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31778622

ABSTRACT

BACKGROUND: A growing provider shortage contributes to the widening gap in significant disparities that rural communities face. To expand access to care for rural-dwelling patients with epilepsy, a national nonprofit organization initiated an integrated, interprofessional telehealth program. OBJECTIVE: To identify gaps in care based on a telepharmacist's recommendations and determine whether these recommendations aligned with Health Effectiveness Data Information Set (HEDIS) performance measures. METHODS: A retrospective chart review was conducted for patients who had an appointment with an integrated interprofessional care team composed of an epileptologist, a social worker, registered nurses, and a pharmacist. This novel approach integrated provision of care by team members at geographically distinct remote locations. The pharmacist conducted comprehensive medical reviews via video conferencing and made recommendations to the epileptologist, primary care provider, and/or patient, as appropriate. The consultation was documented in the electronic health record (EHR). The pharmacist's recommendations were categorized as 1 of the 24 preselected HEDIS performance measures or as a non-HEDIS measure. The analysis used descriptive statistics to report patient demographics and pharmacist recommendations. RESULTS: This study included 86 participants. 86 initial and 36 follow-up appointments were conducted between April 2016 and October 2017. The majority of patients were female (52%), with a mean age of 26.2 years (SD = 14.6, range 4-76) and were taking an average of 6.1 medications (SD = 3.6). 159 comorbidities or conditions were identified in the EHR along with 306 recommendations, for an average of 3.6 recommendations per patient (SD = 3.2). 41 (13.4%) recommendations aligned with preselected HEDIS measures, including medication management for depression (31.7%), hypertension (24.4%), asthma (9.8%), and comprehensive adult diabetes care (14.6%). The remaining 265 recommendations lacked sufficient documentation for categorization or failed to align with any targeted measure. CONCLUSIONS: This retrospective analysis showed that only 13% of pharmacist recommendations aligned with HEDIS quality measures. While it demonstrates the added value of clinical pharmacists in novel telehealth approaches, future work is needed to develop strategies to increase the number of recommendations aligning with HEDIS measures that adhere to national consensus treatment guidelines via telepharmacist training and improved documentation. DISCLOSURES: SinfoníaRx provided funding for this project through a grant to Warholak, Taylor, Axon, and Lott. Bingham, Boesen, Scovis, and Leal are employed by SinfoníaRx. Data from this study were presented at the American Society of Health-System Pharmacists Ambulatory Care Conference 2018; June 4, 2018; Denver, CO, and the Southwestern States Residency Conference 2018; June 15, 2018; Chandler, AZ.


Subject(s)
Patient Care Team/statistics & numerical data , Pharmacists/statistics & numerical data , Referral and Consultation/statistics & numerical data , Telemedicine/statistics & numerical data , Adolescent , Adult , Aged , Appointments and Schedules , Child , Child, Preschool , Electronic Health Records/statistics & numerical data , Female , Humans , Interprofessional Relations , Male , Medication Therapy Management/statistics & numerical data , Middle Aged , Retrospective Studies , Young Adult
11.
Epilepsy Res ; 158: 106235, 2019 12.
Article in English | MEDLINE | ID: mdl-31726287

ABSTRACT

INTRODUCTION: Epilepsy affects 3.5 million people in the United States (US). Rural-dwelling individuals have less access to healthcare and consequently poorer health outcomes. This study describes the outcomes of an interprofessional telehealth program for rural-dwelling individuals with epilepsy in one US state. METHODS: An academic medication therapy management pharmacist provided clinical services to rural-dwelling individuals with epilepsy between November 2015 and June 2018, using video-conferencing technology and follow-up telephonic consultation. Data collected included: demographics, prescribed seizure medications, comorbidities, drug-drug and drug-disease interactions, adverse drug reactions, therapeutic duplications, dose-related safety concerns, adherence concerns, and recommendations to resolve identified issues. Data were summarized using appropriate descriptive statistics. RESULTS: A total of 168 patients (51% male, mean age 28 ± 15 years), participated in this pilot study. Most participants (94%) were prescribed at least one seizure medication including: benzodiazepines (n = 89), lamotrigine (n = 58), and levetiracetam (n = 56). The majority (55%) had at least one comorbidity including: mood disorders (n = 49) and psychiatric disorders (n = 26). Common medications with reported precautions for people with a seizure history were: selective serotonin reuptake inhibitors (n = 18), second-generation atypical antipsychotics (n = 17) and benzodiazepines (n = 16). Participants had at least one: drug-disease interaction (33%), drug-drug interaction (54%), adverse drug reaction (37%), therapeutic duplication (13%); dose-related safety concerns (35%); and medication utilization concerns (13%). DISCUSSION: This pharmacist-delivered pilot program was effective in: reaching underserved patients with epilepsy, identifying and recommending resolutions to medication-related problems, and demonstrating the value of pharmacists in an interprofessional team. Further work is warranted to identify telehealth strategies to reduce medication associated problems.


Subject(s)
Anticonvulsants/pharmacology , Drug-Related Side Effects and Adverse Reactions/drug therapy , Medication Therapy Management , Seizures/drug therapy , Adolescent , Adult , Female , Humans , Male , Middle Aged , Pharmacists , Referral and Consultation
12.
BMC Geriatr ; 19(1): 272, 2019 10 16.
Article in English | MEDLINE | ID: mdl-31619178

ABSTRACT

BACKGROUND: Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures. METHODS: A systematic search using PubMed/Medline, Embase, PsycINFO, CINAHL, and references of identified articles published in English between January 1990 and October 2017 was performed. Two independent reviewers screened titles and abstracts, and then extracted data following a full-text review of included articles with consensus generation and bias assessment. Studies reporting outcomes for melatonin or ramelteon use to prevent delirium in postoperative hospitalized patients (mean age ≥ 50 years) were eligible for inclusion. Data were pooled using a fixed-effects model to generate a forest plot and obtain a summary odds ratio for the outcome of interest (delirium incidence). Cochran's Q and I2 values were used to investigate heterogeneity. RESULTS: Of 335 records screened, 6 studies were selected for the qualitative analysis and 6 were included in the meta-analysis (n = 1155). The mean age of patients in included studies ranged from 59 to 84 years. Patients in intervention groups typically received melatonin or ramelteon at daily doses of two to eight milligrams around cardiothoracic, orthopedic, or hepatic surgeries for one to nine days, starting on the evening before or the day of surgery. The incidence of delirium ranged from 0 to 30% in the intervention groups versus 4-33% in the comparator groups, and was significantly reduced in the melatonin group, with a summary effect of the meta-analysis yielding an odds ratio of 0.63 (95% CI 0.46 to 0.87; 0.006; I2 = 72.1%). A one study removed analysis reduced overall odds ratio to 0.310 (95% CI 0.19 to 0.50), while reducing heterogeneity (Cochran's Q = 0.798, I2 = 0.000). CONCLUSION: Perioperative melatonin reduced the incidence of delirium in older adults in the included studies. While optimal dosing remains an unanswered question, the potential benefit of melatonin and melatonin receptor agonists may make them a reasonable option to use for delirium prevention in older adults undergoing surgical procedures.


Subject(s)
Central Nervous System Depressants/therapeutic use , Delirium/epidemiology , Delirium/prevention & control , Melatonin/therapeutic use , Postoperative Cognitive Complications/epidemiology , Postoperative Cognitive Complications/prevention & control , Aged , Aged, 80 and over , Delirium/psychology , Humans , Incidence , Middle Aged , Postoperative Cognitive Complications/psychology , Randomized Controlled Trials as Topic/methods
13.
BMC Complement Altern Med ; 19(1): 229, 2019 Aug 22.
Article in English | MEDLINE | ID: mdl-31438941

ABSTRACT

BACKGROUND: Use of complementary and alternative medicine (CAM), including vitamins, minerals, herbals, and other dietary supplements, is widespread in the United States (ranging from 24% in Hispanics to 50% in American Indians). Pharmacists are an accessible source for healthcare information, but little is known about their use of CAM products and to whom they would recommend these products. METHODS: A cross-sectional survey was sent via email to pharmacists licensed in one state in the United States in 2015. The survey included items about their use of 10 vitamins and minerals, and 21 herbal or other dietary supplements, as well as reasons for use, conditions used to treat, if they would recommend the product to patients, family, or friends, their perception of CAM safety and effectiveness, and four demographic questions. Descriptive statistics were used to summarize the data, and a chi-square test was used to determine differences between pharmacists' use of vitamins/minerals and herbals/other dietary supplements. The a priori alpha level was 0.05. RESULTS: A total of 639 pharmacists completed the survey. Female pharmacists used vitamins/minerals (p = 0.031) and herbals/others (p = 0.039) more than male pharmacists. Older pharmacists used herbals/others more than younger pharmacists (p < 0.001). Fifty-nine percent thought the dietary supplements in the survey were safe while 32% reported they were effective. Seventy-eight percent of respondents reported use of any vitamin or mineral product versus 42% who reported use of any herbal or other dietary supplement. Commonly used products included: multivitamins (91%), vitamin C (71%), fish oil (65%), probiotics (53%), and fiber (53%). The most commonly reported reason for use was general health and wellness (17-90%). Pharmacists most commonly recommend fiber/psyllium (94%) and calcium (90%) to patients, family, and friends. CONCLUSIONS: Pharmacists in this survey selectively used vitamins, minerals, herbals and other dietary supplements, and recommended some of the more commonly used products to patients, family and friends. This is valuable information given that pharmacists are frontline healthcare professionals who may be asked to provide advice about these products.


Subject(s)
Micronutrients/therapeutic use , Patient Education as Topic/statistics & numerical data , Pharmacists/statistics & numerical data , Plant Preparations/therapeutic use , Adult , Attitude of Health Personnel , Complementary Therapies/statistics & numerical data , Cross-Sectional Studies , Dietary Supplements/statistics & numerical data , Female , Humans , Male , Middle Aged , Patient Education as Topic/methods , Pharmacy , United States/epidemiology , Young Adult
14.
Curr Pharm Teach Learn ; 11(7): 658-663, 2019 07.
Article in English | MEDLINE | ID: mdl-31227087

ABSTRACT

BACKGROUND: This study analyzed the psychometric properties of a cross-sectional survey of student pharmacists' attitudes regarding herbal medications using a polytomous Rasch model. Seven items assessed students' attitudes towards herbal medications using a 6-point agreement scale (0 to 5). Student responses were reviewed to identify outliers and aberrant response patterns, assess scale fit, and perform item analysis. Scale performance was assessed to determine if response categories were independent and equally represented. Items were reviewed for model fit and construct validity with significant item gaps identified using a z-test. IMPACT: A total of 324 students completed the survey. The initial 6-point scale was analyzed. Student responses with outfit mean-square (MNSQ) values >5 were removed, yet the scale did not have appropriate functionality. The categories were merged to form a 4-point scale with no improvement. Therefore, two different 3-point scale options were analyzed: response categories of 0, 1 to 3, and 4 to 5; and response categories of 0, 1 to 4, and 5. With ten students removed, both 3-point scales met the requirements for functionality and all items exhibited good fit with MNSQ values between 0.6 and 1.4, person-separation value of 1.29, and person-reliability value of 0.62. RECOMMENDATIONS: Both 3-point scales met the requirements for Rasch analysis. The most optimal scale was the 0, 1 to 4, and 5 option. DISCUSSION: This study provides findings from the survey validity assessment alongside the survey results, which is useful for readers to have confidence in the quality of the study findings.


Subject(s)
Attitude of Health Personnel , Herbal Medicine/standards , Psychometrics/standards , Students, Pharmacy/psychology , Cross-Sectional Studies , Herbal Medicine/methods , Herbal Medicine/statistics & numerical data , Humans , Psychometrics/instrumentation , Psychometrics/methods , Reproducibility of Results , Students, Pharmacy/statistics & numerical data , Surveys and Questionnaires
15.
Curr Pharm Teach Learn ; 11(2): 139-144, 2019 02.
Article in English | MEDLINE | ID: mdl-30733009

ABSTRACT

INTRODUCTION: Student pharmacists need to work in teams in the educational and practice settings, but there is limited information on their teamwork experiences in the published literature. The study objective was to assess second-year (P2) student pharmacists' teamwork experiences in an experiential quality improvement (QI) course. METHODS: A retrospective pre-post survey was conducted with P2 students to assess teamwork experience attitudes. Students reported their agreement with 17 statements about teamwork, first after the project was planned and again after the project was complete. A Kuder-Richardson 20 score was calculated to assess internal consistency. Differences between pre- and post- groups for each teamwork item were assessed using McNemar's test. An alpha level of 0.05 was used, and a Bonferroni correction was applied for multiple comparisons. RESULTS: Sixty P2 students (50%) responded to the survey. After the project was complete, the majority indicated agreement with good teamwork qualities and disagreement with poor teamwork qualities for most items. More than 60% of respondents indicated they would like to do collaborative work again while 20% of respondents indicated imbalances in member contributions caused conflict within the team. CONCLUSIONS: The majority of student pharmacists in this investigation had positive experiences working in teams, but new important findings from this study indicate that further work is needed to prevent imbalances in team-member contributions and to encourage students to work on future collaborative projects in some cases.


Subject(s)
Education, Pharmacy/methods , Education, Pharmacy/standards , Quality Improvement , Students, Pharmacy/psychology , Arizona , Education, Pharmacy/statistics & numerical data , Humans , Retrospective Studies , Students, Pharmacy/statistics & numerical data , Surveys and Questionnaires
16.
BMJ Open Qual ; 7(4): e000193, 2018.
Article in English | MEDLINE | ID: mdl-30306141

ABSTRACT

IMPORTANCE: While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates. OBJECTIVE: The aim of this study was to determine the rate of community pharmacy dispensing errors in the USA. METHODS: English language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Studies with a denominator reflecting the total number of prescriptions in the sample were necessary for inclusion in the meta-analysis. A random effects meta-analysis was conducted to estimate an aggregate community pharmacy dispensing error rate. Heterogeneity was assessed using the I2 statistic prior to analysis. RESULTS: The search yielded a total of 8490 records, of which 11 articles were included in the systematic review. Two articles did not have adequate data components to be included in the meta-analysis. Dispensing error rates ranged from 0.00003% (43/1 420 091) to 55% (55/100). The meta-analysis included 1 461 128 prescriptions. The overall community pharmacy dispensing error rate was estimated to be 0.015 (95% CI 0.014 to 0.018); however, significant heterogeneity was observed across studies (I2=99.6). Stratification by study error identification methodology was found to have a significant impact on dispensing error rate (p<0.001). CONCLUSION AND RELEVANCE: There are few published articles that describe community pharmacy dispensing error rates in the USA. Thus, there is limited information about the current rate of community pharmacy dispensing errors. A robust investigation is needed to assess dispensing error rates in the USA to assess the nature and magnitude of the problem and establish prevention strategies.

17.
J Manag Care Spec Pharm ; 24(9): 904-910, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30156456

ABSTRACT

BACKGROUND: Managing and treating patients with multiple chronic conditions presents challenges on many levels. Pharmacist-delivered medication therapy management (MTM) services, mandated as part of the Medicare Part D drug benefit, are designed to help patients manage their chronic conditions and medications. OBJECTIVE: To identify factors that influence patient understanding and use of MTM services and potential strategies to educate individuals about MTM. METHODS: Participants who had at least 2 chronic conditions, were taking 2 or more prescription medications, and were aged 18 years or older were recruited from community-based settings to participate in focus groups. The focus groups aimed to identify participants' perceptions and use of MTM services, barriers and facilitators to utilization, and medication problems. Participants were asked to complete a 14-item health care questionnaire and view a brief, 3-minute video introducing the topic of MTM before the group discussion. The health care questionnaire data were analyzed in Microsoft Excel. The focus group responses were transcribed and entered into the computer program ATLAS.ti for thematic analysis. Two independent reviewers qualitatively coded the discussion question responses; a third reviewer investigated discrepancies and facilitated consensus among the reviewers. RESULTS: Participants (N = 27) were mostly female (70.4%), college educated (62.9%), and had Medicare insurance (81.5%). Seven themes were identified: (1) new proposed names for MTM, (2) mechanisms to gain interest in and to promote the value of MTM, (3) familiarity with MTM, (4) pharmacists' training and expertise in MTM, (5) experience with MTM, (6) reasons for nonparticipation in MTM, and (7) preferred method to learn about MTM. Participants did not understand the term "medication therapy management" and felt the interpretation of "therapy"' differed between health care professionals and the public. Some participants used MTM services to learn about appropriate use of their medications, while others were unsure about their eligibility, associated costs, and how to access the services. Participants had limited pharmaceutical knowledge but felt pharmacist-provided MTM services were helpful. Participants were unfamiliar with pharmacists' skills and training. Participants' experiences with MTM services ranged from disregarding the invitation to participate to having pharmacists identify drug-drug interactions. Reasons for nonparticipation in MTM services included being unaware of their eligibility, failing to read excessive information from insurance companies, and being uncertain of the identity of the telephone caller. Preferred methods for learning more about MTM services included the Internet, e-mail, information availability at physician's office, and television advertisements. CONCLUSIONS: These results suggest that the lay public remains largely unaware of MTM services and that the term "MTM" is not well understood. Clearly, tailored public health campaigns and patient engagement strategies are needed to promote MTM in chronic disease management, pharmacists as respected providers, and the importance of the prescriber-MTM pharmacist collaborative relationship in managing medications for patients with multiple chronic conditions. DISCLOSURES: Grant funding from SinfoniaRx to Taylor, Axon, Campbell, Fair, and Warholak was used to help conduct this project. Boesen is employed by SinfoniaRx. The other authors have nothing to disclose. This original research was presented as a poster at the Academy of Managed Care Pharmacy 27th Annual Meeting and Expo; April 7-10, 2015; San Diego, CA.


Subject(s)
Disease Management , Focus Groups/methods , Medicare Part D/trends , Medication Therapy Management/trends , Patient Participation/methods , Prescription Drugs/therapeutic use , Aged , Aged, 80 and over , Chronic Disease , Cross-Sectional Studies , Female , Focus Groups/standards , Humans , Male , Medicare Part D/standards , Medication Therapy Management/standards , Prescription Drugs/economics , Surveys and Questionnaires/standards , United States/epidemiology
18.
J Manag Care Spec Pharm ; 24(8): 813-818, 2018 Aug.
Article in English | MEDLINE | ID: mdl-30058982

ABSTRACT

BACKGROUND: Pharmacist-delivered medication therapy management (MTM) services can improve patient outcomes, yet little is known about outpatient, interprofessional telepharmacy programs. OBJECTIVE: To evaluate an outpatient, interprofessional telehealth chronic care management (CCM) pilot program. METHODS: This 6-month program integrated family medicine providers, a university-based medication management telepharmacist, and an interprofessional care coordinator using telehealth solutions for CCM and pharmacy education services. A physician referred patients at risk for medicine-related problems to the telepharmacist. Eligible patients had 3 or more chronic conditions or took at least 5 medications, were aged 18 years and older, and had at least 1 appointment with their primary care provider during the program. The care coordinator met patients in person to facilitate these virtual clinic processes. The telepharmacist conducted a comprehensive medication review (CMR) via video-conferencing technology, providing CCM based on primary diagnosis, current medications and allergies, laboratory results, and previous chart notes. The consultation was documented in the electronic health record (EHR) for provider review and modification in real time. RESULTS: 69 patients received telepharmacy consultations and on-site registered nurse support during the program. Most patients were female (56.5%), aged 51-70 years (60.1%), Caucasian (72.4%), and non-Hispanic/Latino (71.0%). Patients had 1-9 chronic conditions, such as hypertension (82.6%), diabetes (56.5%), hyperlipidemia (31.9%), depression (30.4%), and osteoporosis (29.0%). Most patients (94.2%) took at least 5 chronic disease medications, such as statins (11.2%), nonsteroidal anti-inflammatory drugs (8.4%), selective serotonin reuptake inhibitors (6.5%), beta blockers (6.5%), and calcium channel blockers (5.6%). The telepharmacist completed 200 interventions for safety (49.0%), vaccines (24.5%), care gaps per national consensus guidelines (13.5%), adherence (10.0%), and cost savings (3.0%). Patients' providers accepted one third (n = 75, 37.5%) of the telepharmacist recommendations (e.g., monitoring and medication changes). CONCLUSIONS: This telehealth program constituted an added service for patients while simultaneously filling a gap in on-site pharmacist counseling services. Integrating the telepharmacist and registered nurse was crucial to clinical service provision. The results are encouraging; however, more research must examine the effectiveness of telehealth services in reaching underserved populations, improving patient care, and decreasing health care costs. DISCLOSURES: External funding from SinfonîaRx was used to help conduct this project. Boesen is employed by SinfonîaRx. At the time this project was conducted, Martin was employed at the University of Arizona Medication Management Center but is now employed by SinfonîaRx. The other authors have no disclosures to report. This original research was presented as a poster at the Academy of Managed Care Pharmacy Nexus 2015; October 26-29, 2015; in Orlando, FL.


Subject(s)
Ambulatory Care/organization & administration , Chronic Disease/drug therapy , Medication Therapy Management/organization & administration , Patient Care Team/organization & administration , Telemedicine/organization & administration , Aged , Ambulatory Care/economics , Ambulatory Care/methods , Chronic Disease/economics , Community Pharmacy Services/economics , Community Pharmacy Services/organization & administration , Cost Savings , Female , Health Care Costs , Humans , Male , Medication Therapy Management/economics , Middle Aged , Patient Care Team/economics , Pharmacists/economics , Pharmacists/organization & administration , Pilot Projects , Referral and Consultation/economics , Referral and Consultation/organization & administration , Telemedicine/economics , Telemedicine/methods
19.
BMC Psychiatry ; 18(1): 130, 2018 05 16.
Article in English | MEDLINE | ID: mdl-29769065

ABSTRACT

BACKGROUND: Depression is one of the most common psychiatric conditions among stroke survivors and is associated with several negative health outcomes. However, little is known about the depression treatment patterns among stroke survivors. The objective of this study was to examine national-level prevalence, patterns and predictors of depression treatment among community-dwelling stroke survivors. METHODS: This study adopted a retrospective, cross-sectional study design using multiple years of Medical Expenditure Panel Survey (MEPS) (2002-2012) data. The study population consisted of older adults (age ≥ 50 years) who (i) were stroke survivors (ICD-9-CM codes of 430-438), (ii) did not die during the calendar year, and (iii) had co-occurring depression (ICD-9-CM code of 296.xx, or 311.xx). Depression treatment, identified by antidepressant medication and/or psychotherapy use, was the dependent variable of this study. Multinomial logistic regression analysis was conducted to examine the association of individual level factors with depression treatment among stroke survivors with co-occurring depression. RESULTS: The final study sample consisted 370 (unweighted) community-dwelling older adults with self-reported stroke and depression. The prevalence of co-occurring depression among stroke survivors was 22.03% [95% Confidence Interval (CI) 19.7-24.4%]. An overwhelming majority (87.6%) of stroke survivors with co-occurring depression reported some form of depression treatment. Antidepressants only and combination therapy was reported by 74.8% (95% CI, 71.6-78.0%] and 12.8% (95% CI, 10.5-15.1%) by stroke survivors with co-occurring depression respectively. Approximately, 61% of stroke survivors with co-occurring depression reported using SSRIs, followed by SNRIs (15.2%), miscellaneous antidepressants (12.1%), TCAs (9.8%), phenylpiperazine antidepressants (5.2%), and tetracyclic antidepressants (4%). Sertraline (15.8, 95% CI, 12.7-19.0%) had the highest reported use among individual antidepressants. CONCLUSIONS: Vast majority (nearly 90%) of the study sample received some form of depression treatment and several individual level factors (such as age, education) were associated with the report of depression treatment use. Future longitudinal studies are warranted to assess the comparative treatment benefits of antidepressants, psychotherapy and their combination. Healthcare providers should carefully assess the risks and benefits of antidepressant (such as SSRIs or TCAs) use in this vulnerable population prior to their use.


Subject(s)
Antidepressive Agents/therapeutic use , Depression/epidemiology , Stroke/psychology , Aged , Combined Modality Therapy , Cross-Sectional Studies , Depression/drug therapy , Depression/etiology , Female , Humans , Independent Living , Male , Middle Aged , Prevalence , Retrospective Studies , Selective Serotonin Reuptake Inhibitors/therapeutic use , Surveys and Questionnaires , United States/epidemiology
20.
J Manag Care Spec Pharm ; 24(5): 416-422, 2018 May.
Article in English | MEDLINE | ID: mdl-29694292

ABSTRACT

BACKGROUND: In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers. OBJECTIVE: To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use. METHODS: This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years. Performance data were downloaded per Medicare contract from the CMS. We matched Medicare insurance provider performance data with the enrollment data of each contract. Mann Whitney U and Spearman rho tests and a hierarchical linear regression model assessed the relationship between provider characteristics, high-risk medication use, and CMR completion rate outcome measures. RESULTS: In 2014, an inverse correlation between CMR completion rate and high-risk medication use was identified among MAPD plan providers. This relationship was further strengthened in 2015. No correlation was detected between the CMR completion rate and high-risk medication use among PDP plan providers in either year. A multivariate regression found an inverse association with high-risk medication use among MAPD plan providers in comparison with PDP plan providers in 2014 (beta = -0.358, P < 0.001) and 2015 (beta = -0.350, P < 0.001), the CMR completion rate in 2015 (beta = -0.221, P < 0.001), and enrollee population size in 2015 (beta = -0.203, P = 0.001). CONCLUSIONS: This study found that MAPD plan providers and higher CMR completion rates were associated with lower use of high-risk medications among beneficiaries. DISCLOSURES: No outside funding supported this study. Silva Almodovar reports a fellowship funded by SinfoniaRx, Tucson, Arizona, during the time of this study. The other authors have nothing to disclose.


Subject(s)
Drug Utilization Review/organization & administration , Medicare Part C/statistics & numerical data , Medicare Part D/statistics & numerical data , Medication Therapy Management/organization & administration , Prescription Drugs , Centers for Medicare and Medicaid Services, U.S. , Contract Services/organization & administration , Cross-Sectional Studies , Drug Utilization Review/statistics & numerical data , Insurance Benefits/statistics & numerical data , Medicare Part C/organization & administration , Medicare Part D/organization & administration , Outcome Assessment, Health Care/methods , Pharmaceutical Services/statistics & numerical data , United States
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