Risk factors for drug therapy problems among Cambodian Americans with complex needs: a cross-sectional, observational study.

BACKGROUND: Pharmaceutical drug therapy problems (DTPs) are a major public health problem. We examined patient-level risk factors for DTPs among Cambodian Americans. METHODS: Community health workers (CHWs) verbally administered surveys and completed a detailed medication review form with participants. A doctoral-level pharmacist reviewed the form with the patient and CHW to determine DTP number and type (appropriateness, effectiveness, safety, and adherence). RESULTS: Participants (n = 63) averaged 55 years old, 6 years of education, 52% were married, 87% spoke Khmer at home, with modal household income <$20,000 (41%). The percentage of participants with DTPs was: 45% appropriateness, 25% effectiveness, 64% safety, and 30% adherence, averaging 3.7 DTPs per patient. In multiple regressions, patient characteristics uniquely predicted each type of DTP. In a multiple regression controlling for number of medications, being married reduced total DTPs (IRR = 0.70) and being depressed increased total DTPs (IRR = 1.26). CONCLUSIONS: Vulnerable patients should be prioritized for pharmacist/CHW teams to identify DTPs.Trial registration: ClinicalTrials.gov identifier: NCT02502929.

Pharmacists and community health workers improve medication-related process outcomes among Cambodian Americans with depression and risk for diabetes.

BACKGROUND: Cambodian Americans have high rates of cardiometabolic and psychiatric disorders and disadvantaged social determinants of health (SDOH). These factors can make it challenging to resolve drug therapy problems (DTPs) and improve medication-related outcomes. This manuscript reports planned analyses from a randomized controlled trial in which participants were randomized to one of 3 treatment arms: (1) community health worker (CHW)-delivered lifestyle intervention called Eat, Walk, sleep (EWS), (2) EWS plus pharmacist/CHW-delivered medication therapy management (EWS + MTM), or (3) social services (SS: control). OBJECTIVES: We compared the 3 arms on changes in self-reported medication adherence, barriers, and beliefs. Within the EWS + MTM arm only, we assessed the impact of EWS + MTM on DTP resolution and examined predictors of DTP resolution. METHODS: Cambodian Americans at the age of 35-75 years at high risk of developing diabetes and meeting the criteria for likely depression (N = 188) were randomized (EWS, n = 67; EWS + MTM, n = 63; SS, n = 50; control). For all participants, self-reported surveys were collected at baseline, 12 months, and 15 months. DTPs were assessed on the same schedule but only for participants in the EWS + MTM. RESULTS: All 3 groups reported a significant decrease in barriers to taking medications. Compared with the other arms, the EWS + MTM arm reported a decrease in forgetting to take medications at 15 months. In the EWS + MTM arm, mean DTPs per patient was 6.57 and 84% of DTPs were resolved. SDOH predictors of DTP resolution included years of education (odds ratio [OR] 0.94, P = 0.016), ability to write English (OR 0.73, P = 0.015), difficulty communicating with provider (OR 1.39, P < 0.001), private insurance (OR 1.99, P = 0.030), disability (OR 0.51, P = 0.008), and years living under Pol Pot (OR 0.66, P = 0.045). Medication barriers at baseline predicted DTP resolution (OR 0.79, P = 0.019) such that each additional barrier was associated with a 21% reduction (1-0.79) in the odds of having a resolution. CONCLUSION: CHWs can reduce medications barriers and help pharmacists reduce DTPs in disadvantaged populations.

Experiences with Cyclical User-Centered Design for Patient and Clinician Facing Medication Reconciliation mHealth Applications.

Accurate medication lists are essential data required to make clinically informed decisions. Obtaining a comprehensive, up-to-date medication list is difficult for clinicians. Patients have limited input into reviewing and reconciling their own medication data. Ideally, a medication list would comprise a 360-degree view of all prescribed, dispensed, purchased medications and would seamlessly connect patients and providers to medication data from multiple sources. While an ideal medication list would capture every aspect of medication management, in reality a Best-Possible Medication History (BPMH) is a more achievable goal. In an effort to realize a BPMH and to facilitate the goals of the State of Connecticut's Office of Health Strategy's Medication Reconciliation and Polypharmacy Committee (MRPC), we engaged stakeholders (patients, clinicians, advocates) in focus-groups and interviews to solicit feedback on the user interface requirements for a BPMH. Feedback was obtained via facilitated discussions that occurred in-person, via virtual meetings, and through online surveys.

Pharmacists' Experiences, Perceptions, and Knowledge of Direct-to-Consumer Prescription Coupons.

BACKGROUND: Despite widespread use of manufacturer-sponsored prescription drug coupons and pharmacy network discount cards (i.e., direct-to-consumer prescription coupons), little is known about community pharmacists' experiences, perceptions, and knowledge of coupon cards. OBJECTIVE: To identify community pharmacists' experiences, perceptions, and knowledge of prescription coupons. METHODS: An 11-item telephonic survey was conducted from August 2018 to March 2019. Eligible respondents included English-speaking pharmacists employed during the survey period in a community pharmacy physically located in Connecticut. Data were analyzed via descriptive statistics and one-way analysis of variance (ANOVA). One-way ANOVAs were conducted to test the relationship between the respondents' practice types, the average daily volume of coupons processed, and the average time needed to process each coupon. The responses were based on a 5-point Likert scale and dichotomized to enable interpretation of the results. RESULTS: There were 240 surveys completed from an eligible pool of 691 community pharmacy sites (34.7% response rate). Respondents representing 60 different businesses located across 123 of the state's 282 major ZIP codes, representing 83.5% of the state's population. Respondents overwhelmingly held positive perceptions of the ability of prescription coupons to increase patients' medication access (91.7 %) and reduce out-of-pocket costs (93.3%). However, respondents also believed patients have trouble paying for prescriptions once coupons expire (70.8%). When questioned about privacy practices, 57.5% of respondents believed that it is illegal to "sell patients' information" (i.e., with no distinction made between protected health information and any other information), while another 25.8% declined to answer, citing they did not know. Only 20.8% (n = 50) of respondents knew that community pharmacies could see lowered reimbursement from accepting network drug discount cards, and 40.4% (n = 97) knew that pharmaceutical manufacturers can cover the difference in patients' copay costs. Approximately 10% of respondents believed (incorrectly) that discounts from pharmacy network discount cards were covered via patients' prescription insurance and/or the third-party discount card vendor companies (7.9% and 3.3%, respectively). Respondents believed patients received prescription coupons most often from the internet or mail (77.1%), their prescribers (62.9%), or from their own community pharmacies (33.3%). Finally, on average, respondents processed 14.6 (SD 19.8) coupons per day and required 4.8 (SD 4.3) minutes for each claim. CONCLUSIONS: As far as we know, this is the first exploration of community pharmacists' experiences, perceptions, and knowledge of direct-to-consumer prescription coupons. Results show that, while community pharmacists overwhelmingly hold positive perceptions towards prescription coupons and drug discount cards, there is an opportunity to increase general understanding of the differences in business practices between manufacturer-sponsored prescription drug coupons and pharmacy network discount cards. Community pharmacies also spend a significant amount of time processing coupon claims. DISCLOSURES: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare no relevant conflicts of interest or financial relationships. This study was presented as a poster at the 2019 American Society of Health Systems Pharmacists Midyear Clinical Meeting during December 8-12, 2019, in Las Vegas, NV.