Impact of pharmacist prescribing through direct pharmacy access policies on access to hormonal contraception.

BACKGROUND/OBJECTIVE: This study assesses the impact of direct pharmacy access (DPA) policies that allow pharmacists to prescribe hormonal contraceptives on women's access by comparing access among 3 groups: (1) women in a state without DPA (Indiana), (2) women in a state with DPA, but not using DPA, and (3) women in a state with DPA and using DPA. METHODS: This cross-sectional survey, including a scale to measure access to contraceptives, perception items, and demographics, was distributed through Amazon Mechanical Turk (Amazon.com, Inc). Kruskal-Wallis tests and linear regression analysis were used. RESULTS: The sample size was 316. When controlling for education, income, and age, the women not using DPA (in Indiana and a DPA state, respectively) reported significantly higher levels of approachability (P < 0.001 and P < 0.001, respectively), acceptability (P < 0.001 and P < 0.001, respectively), availability and accommodation (P < 0.001 and P = 0.009, respectively), affordability (P < 0.001 and P < 0.001, respectively), and appropriateness (P < 0.001 and P < 0.001) access than the women using DPA. The women using DPA reported significantly lower levels of privacy access than those not using DPA in a DPA state (P = 0.004) when controlling for education, income, and age. However, 78.9% of women using DPA agreed DPA made obtaining contraceptives easier. Most of the women who had never used DPA were previously unaware of DPA (81.1% in DPA states and 86.2% in Indiana) but felt that it would improve access (82.8% and 80.0%, respectively). CONCLUSION: Understanding the effects of DPA policies on women's access to contraceptives can inform future policies and support implementation. Lower levels of access across all dimensions among those using DPA may be influenced by imperfect implementation and failure to legislatively enable the sustainability of this service rather than pharmacists' ability to improve women's access.

A mixed-methods study of pharmacy instructors' early experiences with a teaching electronic medical record.

INTRODUCTION: As use of electronic medical records (EMRs) increases in healthcare, multiple accreditation organizations recommend training future clinicians on EMRs as part of the academic curriculum. Therefore, some pharmacy programs now utilize an academic EMR. Our objective was to examine pharmacy instructors' early experiences with a commercially available teaching EMR (tEMR) in order to identify current and future priorities along with benefits and barriers to academic EMR use in pharmacy education. METHODS: We conducted semi-structured interviews and a web-based survey with pharmacy instructors. Interview and survey data analyses consisted of hybrid inductive/deductive approaches to coding data and descriptive statistics, respectively. We mapped themes to the Pharmacists' Patient Care Process (PPCP). RESULTS: Seven instructors participated in interviews, and 10 completed the survey. We identified 25 interview themes that were generally congruent with survey responses. A noted benefit of the tEMR was providing a large repository of real-life patient data. Instructors' current priorities for tEMR activities primarily aligned with "collect," "assess," and "plan" steps of the PPCP. One reported barrier was insufficient training regarding the tEMR capabilities. Instructors offered innovative ideas for future academic EMR use, including pharmacokinetics, incident reporting, and longitudinal cases. CONCLUSIONS: Study findings are most applicable to pharmacy programs in the early stages of academic EMR adoption. We identified opportunities for pharmacy programs to facilitate innovative, future use of academic EMRs, including curriculum planning, so pharmacy students gain experience using EMR functions for each PPCP step and develop more advanced EMR skills.

Perceptions of working conditions and safety concerns in community pharmacy.

BACKGROUND/OBJECTIVE: Working conditions within community pharmacy can impact pharmacists and their ability to provide safe patient care. The objective of this study was to determine pharmacists' perceptions of working conditions while controlling for respondent (years of experience, degree, work status) and workplace variables (prescription volume, type of community setting). METHODS: This mixed-methods study used a cross-sectional survey to investigate community pharmacists' perceptions of company climate (at the store level, corporate level, as well as fear of discipline), workflow issues, and career satisfaction. Items utilized a seven-point Likert-type response format (1 = strongly disagree to 7 = strongly agree). Linear regression was used to assess relationships between perceptions and years of experience, degree, work status, prescription volume, and type of community setting. A free-response question captured perceptions of safety concerns. An adapted version of the Agency for Healthcare Research and Quality integrative model of health care working conditions on organizational climate and safety was used as a framework for this analysis. RESULTS: Respondents working in national chains had significantly more fear of being disciplined for following policies to promote safety and addressing patient safety concerns than respondents in independent (P < 0.001) and grocery and big box stores (P < 0.001), when controlling for years of experience in community pharmacy, degree, and prescription volume. Most participants (n = 805, 96.9%) indicated organizational or company level factors were the most substantial threat to safety, with work design and quality emphasis being the second most frequently mentioned hazards. CONCLUSION: Company climate and workflow were perceived negatively in all community settings but were perceived the most negatively by those working in chain pharmacies. A majority of pharmacists feared being disciplined for addressing safety concerns with management, which may be detrimental to patient safety. Further research on how to improve working conditions is warranted.

Opioid prescribing and health outcomes in opioid-naive patients: Analysis of a statewide health information exchange.

BACKGROUND: Widespread use of prescription opioids is associated with adverse outcomes. OBJECTIVE: To identify factors associated with adverse health outcomes and health care use using a statewide health information exchange. METHODS: This is a retrospective cohort study using the Indiana Network for Patient Care. Adult opioid-naive patients who received an opioid prescription between January 2012 and December 2017 were included. The outcomes included (1) a composite outcome of any combination of opioid abuse, dependence, or overdose, (2) all-cause mortality, and (3) health care use. Independent variables included opioid dosage, dispensed amount, days supply, concurrent use of short-acting (SA) and long-acting (LA) opioids, and concurrent use with benzodiazepine or gabapentinoids. Additional variables included patients' age, sex, race, modified Charlson Comorbidity Index score, mental health conditions, and medications for opioid use disorders. Factors associated with composite outcome and mortality were identified using Cox proportional hazards and reported as adjusted hazard ratio (aHR) and 95% CI. Factors associated with health care use were identified using Poisson regression and reported as adjusted incidence rate ratio (aIRR) and 95% CI. RESULTS: 1,328,287 opioid prescriptions were identified for 341,722 patients. Opioid-related factors associated with the composite outcome, mortality, and hospitalizations, respectively, included opioid dosage (aHR 1.003 [95% CI 1.001-1.006]; aHR not applicable; aIRR 1.07 [1.06-1.08]), opioid days supply (aHR 1.03 [1.02-1.03]; aHR 1.009 [1.005-1.014]; aIRR 0.94 [0.92-0.96]), concurrent SA/LA opioids (aHR 2.12 [1.78-2.54]; aHR 1.40 [1.14-1.70]; aIRR 1.40 [1.37-1.42]), and use of benzodiazepines/gabapentinoids (aHR 1.68 [1.38-2.04]; aHR 1.23 [1.01-1.51]; aIRR 1.25 [1.23-1.27]). CONCLUSION: Many factors are associated with poor health outcomes, especially concurrent use of SA and LA opioids and overlapping prescriptions of opioids with benzodiazepines or gabapentinoids. Identification of factors associated with adverse outcomes may help identify patients at risk for poor outcomes and could inform possible interventions.

Policy solutions to address community pharmacy working conditions.

OBJECTIVE: Increasing attention has been drawn to poor working conditions in community pharmacy, the impact on patient safety, and the role of pharmacy benefit managers (PBMs) in the United States. This study assessed community pharmacists' perceptions of potential solutions to improve working conditions. METHODS: This mixed-methods, survey-based study explored pharmacists' proposed solutions for improving working conditions. The participants' perceptions of solutions at the company and state or national levels were assessed using a 7-point Likert-type response format (from 1 = strongly disagree to 7 = strongly agree). Multiple regression assessed the relationships between participant perceptions and pharmacy type (e.g., national chain, grocery, or independent), pharmacy degree, age, average number of prescriptions processed daily (prescription volume), and years of experience. The participants' perceptions of how to improve working conditions were explored to provide more depth and nuance to the understanding of these issues. RESULTS: The sample size was 1222 participants. Respondents working for national chains were statistically significant more in favor of limiting the number of prescriptions verified per pharmacist and less in favor of addressing reimbursement issues than those working for grocery or big-box stores (P = 0.001 and P = 0.006, respectively) and independent pharmacies (P < 0.001 and P < 0.001, respectively), when controlling for years of experience, degree, and prescription volume. Although addressing staffing issues and changing corporate priorities were immediate concerns, the participants felt that regulating PBM reimbursement practices should be the first priority. CONCLUSION: Identifying solutions from employee stakeholders may be an effective way to inform actions that both employers and extraorganizational entities can take to improve pharmacist working conditions and patient care. Restricting PBMs was the most preferred solution, followed by direct and indirect reimbursement for nondispensing services. However, working conditions in community pharmacy are influenced by multiple factors that often are dependent on one another. Thus, a multifaceted approach will likely be required to improve working conditions.

The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model.

BACKGROUND: Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood. OBJECTIVES: The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care. METHODS: Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis. RESULTS: Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized. CONCLUSIONS: Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.

Pharmacy students' perspectives on the initial implementation of a teaching electronic medical record: results from a mixed-methods assessment.

BACKGROUND: Electronic medical records (EMRs) have been used for nearly three decades. Pharmacists use EMRs on a daily basis, but EMRs have only recently been incorporated into pharmacy education. Some pharmacy programs have implemented teaching electronic medical records (tEMRs), but best practices for incorporating tEMRs into pharmacy education remain unknown. The objectives of this study were to 1) assess pharmacy students' views and experiences with a tEMR; and 2) identify current learning activities and future priorities for tEMR use in pharmacy education. METHODS: We used a mixed-methods approach, including three, two-hour student focus groups and a 42-item web-based survey to examine student perspectives of the tEMR. All first, second, and third year professional pharmacy students were eligible to participate in the survey and a focus group. Web-based survey items were measured on a 7-point Likert scale, and quantitative analyses included descriptive statistics. Two researchers independently coded transcripts using both deductive and inductive approaches to identify emergent themes. These analysts met and resolved any coding discrepancies via consensus. RESULTS: Focus groups were conducted with 22 total students, with 6-8 students represented from each year of pharmacy training. The survey was completed by 156 students: 47 first year, 55 second year, and 54 third year. Overall, 48.7% of survey respondents altogether agreed or strongly agreed that using the tEMR enhanced their learning in pharmacy classes and laboratories. Qualitative data were organized into four major themes regarding tEMR adoption: current priorities for use within the pharmacy curriculum; tEMR benefits; tEMR barriers; and future priorities for tEMR use to prepare students for pharmacy practice. CONCLUSIONS: This study reveals pharmacy students' perspectives and attitudes towards using a tEMR, the types of classroom activities that incorporate the tEMR, and students' future suggestions to enhance the design or application of the tEMR for their learning. Our research findings may aid other pharmacy programs and promote more effective use of tEMRs in pharmacy education. In the long-term, this study may strengthen pharmacy education on EMRs and thus increase the efficacy and safety of pharmacists' EMR use for patients' medication management.

Pharmacists' impact on older adults' access to vaccines in the United States.

OBJECTIVE: The purpose of this systematic review was to explore pharmacists' impact on older adults' access to vaccines in terms of realized accessibility, financial accessibility, and vaccine availability. METHODS: Five databases were searched using a search strategy developed in PubMed and translated to other databases. Included studies were English-language, United States-based primary literature published between 1994 to present day. Studies were excluded if they were incomplete studies or did not focus on at least one of three dimensions of access to immunizations: realized accessibility, availability, and financial accessibility. The following data were gathered: title, authors, year published, sub-dimension of accessibility, health care setting, intervention or data source, pharmacist role, type of immunization, duration of study, sample size, and main outcome measures. RESULTS: Twenty-five studies met the inclusion criteria. Of those, the majority evaluated realized accessibility (n = 22, 88%). Eleven studies evaluated vaccine availability, and one study addressed financial accessibility. Pharmacists had a variety of roles in the immunization process, including screener, educator, immunizer, or documenter, and often played more than one role (n = 10, 40%). Pharmacists participated in the vaccination process across multiple health care settings, including in community pharmacies (n = 8, 32%) and hospitals (n = 7, 28%). In the majority (n = 21, 84%) of studies, pharmacists positively impacted older adults' access to vaccines. The most common vaccinations studied were pneumococcal and influenza vaccinations (n = 20, 80%). CONCLUSION: Vaccinations are important in protecting and maintaining the health of older adults. Pharmacists improved access to vaccinations and served many roles in the vaccination process. Future research should explore how pharmacists impact access to vaccines beyond vaccination rates, especially regarding the financial impact on patients.

Pharmacy Student Perceptions and Preferences of In-person Versus Video-Recorded Evaluations in Skills-Based Courses.

Objective. To determine pharmacy students' preferences for and perceptions of in-person and video evaluations.Methods. A mixed methods survey was administered to 447 first-, second-, and third-year students enrolled in a public US Doctor of Pharmacy program. A survey instrument with 14 quantitative items and four qualitative items was used to measure student perceptions. Eight response choice items measured preferences. Paired t tests were used to compare students' perceptions. Independent t tests were used to compare perceptions between students who experienced and had not experienced video evaluations. Two researchers performed thematic content analysis of the qualitative responses.Results. Students (n=444, 99.3% response rate) perceived in-person evaluations more positively for all items except nervousness. Students who experienced video technology felt significantly more positive about video evaluations than students who had little or no experience using video technology on nine items. The students who experienced video technology felt significantly less positive toward video evaluations in terms of quality (1.24 vs. 0.83) and amount (1.14 vs 0.77) of written feedback. Although students valued the interaction with a larger, more diverse pool of evaluators that was made possible by video evaluations, they did not view video technology as applicable to their future practice.Conclusion. Students viewed in-person evaluations significantly more positively than video evaluations. This effect was mitigated by greater exposure to video technology, suggesting that concerns regarding video evaluations are based on conjecture rather than experience. This study highlights the need to reduce the technological issues associated with video evaluations and improve the written feedback provided to students.

Social and legislative shaping of access to contraceptives and the pharmacist's role: A literature review.

BACKGROUND: Despite years of research and numerous policies, access to contraceptives in the United States remains imperfect. Largely due to lack of access to contraceptives, unintended pregnancy rates remain high. OBJECTIVE: To provide researchers and policy-makers with a comprehensive review of the legislative and social landscape that has shaped contraceptive access in the United States, which may help to guide future research and policies. METHODS: A narrative overview of existing literature on policies and research regarding women's access to contraceptives was compiled, with a focus on the role of pharmacists. RESULTS: Contraceptive access has been heavily influenced by laws and policies throughout the years, and disparities remain in underserved populations. Pharmacists are beginning to play a role in improving access to contraceptives through provision of contraceptives using direct pharmacy access policies. CONCLUSIONS: Continued research and new policies aimed at improving contraceptive access are warranted.

Employment Trends for Doctor of Pharmacy Graduates of Research-Intensive Institutions, 2013-2017.

Objective. To determine the current state of employment for doctor of pharmacy (PharmD) graduates based on 5-year trends among graduates of research-intensive institutions and the Pharmacist Demand Index. Methods. Data from a cross-sectional survey of PharmD graduates from 10 research-intensive colleges of pharmacy conducted over a 5-year period were used to generate an overview of graduating students' experiences and the outcomes of their job searches. Results. The average response rate of graduates of programs over the 5 years was 75.4%. Overall, 86% of graduates had postgraduate placements (ie, jobs, residencies, fellowships, further education) at the time of graduation. Across all years, 85% of respondents who had placements indicated they were satisfied with the postgraduation offer they received. Conclusion. An examination of postgraduate outcomes of research-intensive schools and the Pharmacist Demand Indicator over the past 5 years indicates a trend toward a balance between the supply and demand for pharmacists. Careful attention needs to be given to these two metrics moving forward.

Development of a Unique Student Pharmacist Internship in a Primary Care Provider System.

PURPOSE: To describe a unique pharmacy intern program in a group of federally qualified health center (FQHC) outpatient primary care provider clinics. SUMMARY: A pharmacy intern program was created at the North Central Nursing Clinics in Indiana, a group of four FQHC outpatient primary care provider facilities. Intern-performed tasks included: Prior authorization (PA) requests, medication assistance program (MAP) applications, sample procurement and inventory, and contraceptive devices for implantation inventory management. Interns interacted with clinic administration, nurse practitioners, and medical staff to complete their assigned responsibilities. Over a one-year period, the interns completed documentation on more than 2000 charts during a combined 12 h a week. Interns identified the interprofessional interactions as the most beneficial experience, while providers acknowledged no difference in the processing of paperwork during the transition of duties from pharmacy fellow to intern. CONCLUSION: This unique pharmacy intern program was successfully created and implemented in a primary care provider office, resulting in learning opportunities for pharmacy interns, as well as operational efficiencies to fellows, providers, and the organization.

Impact of a teaching objective structured clinical examination (TOSCE) on student confidence in a pharmacy skills laboratory.

OBJECTIVE: To describe the relationship between the use of a teaching objective structured clinical examination (TOSCE) and student confidence in a pharmacy skills laboratory. METHODS: To develop students' abilities in providing recommendations and patient education on selected drug products, third-year pharmacy students participated in a TOSCE in a men's and women's health laboratory. A 19-item, 5-point Likert scale survey was administered longitudinally to assess student confidence (1 = not all confident to 5 = extremely confident). An additional seven items (1 = strongly disagree to 5 = strongly agree) were added to the original 19-item survey to measure changes in confidence and attitude before and after a problem-based assessment. RESULTS: Seventy-two students completed all five surveys administered throughout the semester. Students' confidence improved in multiple areas within the clinical skills and interpersonal communication skills categories. Students also indicated their confidence in using primary literature, electronic drug references, and package inserts to answer medication-related questions improved after the TOSCE implementation. Students agreed that the feedback they received from the TOSCE was beneficial to their performance on a problem-based assessment. CONCLUSIONS: A TOSCE is a formative assessment that has the potential to improve student confidence in core competency areas immediately after an activity. However, its benefit may be short-term when a time gap exists. Further study is needed to assess long-term sustainability in student confidence over multiple laboratory activities throughout a semester.

Evaluation of a nursing and pharmacy student educational activity promoting interprofessional learning.

BACKGROUND: Nurses and pharmacists are essential healthcare team members and must collaborate to provide safe and effective patient care. The purpose of this study was to evaluate nursing and pharmacy student views on interprofessional collaboration after completing an educational activity. INTERPROFESSIONAL EDUCATION ACTIVITY: Students participated in an interprofessional activity designed to improve empathy toward older adults and completed an open-ended questionnaire post-activity regarding their experience and views on interprofessional collaboration. Content analysis identified themes grounded in the responses. Students (n = 216) felt communication needed improvement (n = 31, 16.8%), were frustrated with fragmented care (n = 31, 16.8%), found interprofessional collaboration necessary (n = 37, 20.1%), and enjoyed the interprofessional experience (n = 17, 9.2%). DISCUSSION: Study results provide evidence for the inclusion of additional structured interprofessional activities into all health professions curriculum to emphasize collaboration, improve communication, and modify views in preparation for interprofessional practice.

Mental health first aid training among pharmacy and other university students and its impact on stigma toward mental illness.

BACKGROUND AND PURPOSE: Information on effective and replicable methods employed in pharmacy and other college students to combat stigmatizing beliefs toward those with mental illness is limited. Mental Health First Aid (MHFA) is an international, standardized, eight-hour course focused on helping members of the general public triage a mental health crisis. The objective of this study was to determine the effect of MHFA training on stigmatizing attitudes toward those with mental illness among pharmacy and non-pharmacy students. EDUCATIONAL ACTIVITY AND SETTING: Pharmacy and non-pharmacy students were invited to voluntarily participate in one of two MHFA sessions. A survey utilizing the Social Distance Scale (SDS) and Attitudes to Mental Illness Questionnaire (AMIQ) was given to participants before and after the MHFA session to assess change in stigmatizing behavior. FINDINGS: Thirty-four pharmacy students and 21 non-pharmacy students participated in the study. Overall, stigma toward depression and schizophrenia decreased. For the SDS schizophrenia vignette, a statistically significant improvement (p < 0.05) was seen on six of the seven responses for pharmacy students and on four responses in non-pharmacy students. Both pharmacy and non-pharmacy students improved on one item in the SDS depression vignette. For the AMIQ, pharmacy students demonstrated statistically significant improvement on four items in the schizophrenia vignette and five items in the depression vignette. Non-pharmacy students showed improvement on two items for both the AMIQ schizophrenia and depression vignettes. DISCUSSION AND SUMMARY: MHFA was effective in decreasing stigmatizing beliefs among pharmacy and non-pharmacy students. These findings support the utilization of teaching methods that emphasize the patient experience and humanize mental illness.

Assessment of student pharmacists' ethical decision-making.

INTRODUCTION: In previous research, investigators have expressed concern about the ethical ambivalence of pharmacists in decision-making. The objectives of this study were to examine student pharmacists': 1) attitudes and responses regarding specific common ethical situations and 2) perceived level of difficulty in making ethical decisions. METHODS: A self-administered 38-item survey was given to second and third year student pharmacists at Purdue University. The survey comprised five sections, including: 1) attitudes towards common ethical situations, 2) responses to specific ethical scenarios, 3) emergency lending, 4) perceived level of difficulty in resolving ethical dilemmas, and 5) demographics. RESULTS: Over 90% of students agreed or strongly agreed that pharmacists have the right to refuse to dispense a medication for clinical reasons, while 45.3% agreed or strongly agreed that pharmacists had the right to refuse to dispense for moral or religious reasons. Greater than 20% of students were undecided about dispensing syringes without a prescription, pseudoephedrine tablets to a frequent purchaser, and lethal doses of narcotics. In eight out of nine cases involving ethical decision-making, over 70% of students perceived the decision to be somewhat problematic. DISCUSSION AND CONCLUSIONS: Exploration of student pharmacists' perceptions of specific ethical situations assists in identifying areas of uncertainty in decision-making and informing educational interventions that may foster ethical development of future pharmacy professionals.

Opioid and Benzodiazepine Weaning in Pediatric Patients: Review of Current Literature.

Pediatric opioid and benzodiazepine withdrawal are avoidable complications of pain and sedation management that is well described in the literature. To prevent withdrawal from occurring, practitioners regularly use a steady decrease of pain and sedation medications, also known as a weaning or tapering schedule. The weaning schedule is highly variable based on clinician preference and is usually dependent on the clinician. The purposes of this review are to evaluate the current literature on the process of opioid and benzodiazepine weaning in pediatric patients and to assess the various standardized protocols used to decrease withdrawal occurrences. We conducted a search of the PubMed, MEDLINE, Cochrane Library, Cumulative Index of Nursing and Allied Health (CINAHL), Academic Search Premier, and PsycInfo databases. Studies were included if they described a wean or taper in pediatric patients aged 18 years or younger. Studies describing neonatal abstinence syndrome were excluded from the review. A total of 97 studies published between 2000 and 2014 were retrieved; of those, 15 studies met the inclusion criteria. Studies were evaluated for selection of withdrawal assessment tool, wean protocol summary, preferred weaning agents, benzodiazepine withdrawal, and wean-at-home regimen. The most common opioid-weaning protocol approaches described a 10-20% dose decrease per day. Benzodiazepine weaning was not regularly standardized or described. The use of a standardized opioid-weaning protocol reduced withdrawal rates compared with nonstandardized weaning plans. Benzodiazepine weaning was inconsistently evaluated and may have affected study outcomes. Identified areas of improvement include the use of newer withdrawal assessment tools validated in the older pediatric population and standardized withdrawal assessment and reporting.

The association between family caregivers' involvement in managing older adults' medications and caregivers' information-seeking behavior.

OBJECTIVES: 1) To explore the association between family caregivers' involvement in managing care recipients' medications and their information-seeking behavior related to caregiving; and 2) to examine the sources used by caregivers when seeking information. METHODS: A retrospective analysis of cross-sectional data from 2 national studies, the 2011 National Health and Aging Trends Study (NHATS) and its supplement, the National Study of Caregiving (NSOC), was conducted. A nationally representative sample of community-dwelling adults (≥65 years of age) completed NHATS interviews, and a sample of their family caregivers participated in NSOC. Caregiver involvement in medication management was assessed with the use of 2 items asking caregivers if they helped keep track of care recipients' medications or helped with injecting medications. Information seeking was assessed with the use of an item asking caregivers if they ever looked for caregiving-related information. RESULTS: Out of 1367 caregivers interviewed, 54% reported helping to keep track of care recipients' medications and 8.7% assisting with injecting medications. Approximately 10.2% (n = 149) of caregivers reported seeking information to help them care for their care recipients. Caregivers sought information primarily on their own either through online resources or asking friends or relatives (73.3%). Sixty-four percent also sought information from medical providers or social workers. Adult children of caregivers were more likely to seek information for their older adult parents, based on bivariate analysis (P <0.01). In multivariable-adjusted models, caregivers who helped to keep track of medications had 2.30 (95% confidence interval [CI] 1.18 to 4.51) times higher odds of seeking information to help them to provide care for their care recipients. Caregivers helping with injecting medications were less likely to seek information (odds ratio 0.32, 95% CI 0.14 to 0.76). CONCLUSION: Specific caregiver responsibilities, such as assisting with medication management activities, are associated with caregivers' information-seeking behavior related to care recipients' health. Health care providers, including pharmacists, can play an important role in helping caregivers to identify proper resources for information and in educating them about medication management.

Correlates of caregivers' involvement in the management of older adults' medications.

BACKGROUND: Family caregivers are actively involved in medication management, yet little is known about factors associated with caregivers' involvement in this role and how that information can be utilized to engage caregivers in the healthcare system. OBJECTIVES: To explore factors associated with caregiver involvement in various aspects of older adults' medication management (i.e., ordering, keeping track or ensuring the correct medication is taken at the correct time, and injecting medications). METHODS: A retrospective analysis of two national surveys, the 2011 National Health and Aging Trends Study and the National Study of Caregiving was performed. Multivariate logistic regression models were used to examine the associations between demographic and caregiving variables with caregiver involvement in three medication management activities. RESULTS: Approximately two-thirds of family caregivers (N = 1369) were involved in one or more medication management activities. Factors associated with caregivers' assistance with ordering medications included being female, high frequency of involvement in instrumental activities of daily living (IADLs), involvement in medically-related activities, and caring for an older, less educated, or Hispanic care-recipient and individuals with lung disease or dementia (p < 0.05). Caregiver living arrangement, high frequency of involvement in activities of daily living (ADLs) and IADLs, involvement in medically-related activities along with care-recipient's race/ethnicity and having a dementia diagnosis were all associated with caregiver assistance in keeping track of medications (p < 0.05). Factors associated with assistance in injecting medications were caring for older adults with diabetes or stroke, or being involved in medically-related activities (p < 0.05). CONCLUSIONS: Different demographic and caregiving factors were associated with caregiver involvement in various medication management activities. Recurring factors included race/ethnicity, certain care-recipient disease states, and caregiver involvement in IADLs and medically-related activities. Healthcare providers can play a proactive role in engaging caregivers in discussion about medication management and these findings can help practitioners more effectively target caregivers for education and support.