Identifying Opportunities for Impact of Community-Based Pharmacist-Led Biometric Health Screenings on ASCVD Risk.

Introduction: Community-based pharmacists are positioned uniquely to assist in the early detection of underlying cardiovascular disease (CVD) which affects approximately 50% of adults in the United States. Organizations utilize community-based pharmacists to conduct annual biometric health screenings to help employees identify health risks previously undetected. The goal of this study was to evaluate how community-based pharmacists could impact lifetime atherosclerotic cardiovascular disease (ASCVD) risk for a large population. Methods: This study was a retrospective analysis of annual pharmacist-led 15-minute biometric health screening data from a large regional community-based pharmacy chain. Employees between the ages of 20 and 79 who had completed at least three biometric health screenings between July 1, 2015 and June 30, 2020 were included. Incomplete biometric health screening records were excluded. To calculate lifetime ASCVD risk and identify perceived gaps in care, prescription fill history of study participants was used. The pharmacists did not make clinical interventions; however, education was provided with the information found. Results: A total of 10,001 patients were included. Median baseline ASCVD risk was 1.5% and increased to 1.8% (p < 0.001). Additionally, 1,187 patients with an elevated ASCVD risk ≥ 7.5%, showed statistically significant improvements in blood pressure, body mass index, and cholesterol. Conclusions: Improvements for high-risk patients were seen in several biometric health screening parameters including blood pressure, body mass index, and cholesterol. Community-based pharmacists were well positioned to intervene clinically to support reduction of ASCVD life-time risk.

Pilot Evaluation of Pharmacists' and Pharmacy Technicians' Knowledge and Understanding of a Medication Synchronization Program.

Background: Medication synchronization (MS) improves adherence by allowing patients to pick up all medications at the same time. Pharmacy staff need training to utilize a MS program effectively. Objective: Evaluate the impact of a video tutorial with decreased extraneous and intrinsic load on pharmacists' and pharmacy technicians' knowledge and understanding of a MS program. Study Method: Participants completed a prequestionnaire to assess knowledge and understanding of the MS process. They then watched a step-by-step video tutorial and were reassessed by a postquestionnaire 2 weeks later. Study participants included pharmacists and pharmacy technicians employed at 1 of 2 pharmacies in 1 regional division of a large community-based chain pharmacy. Participants were eligible if they were registered and in good standing with the Kansas Board of Pharmacy and employed for greater than 30 days since July 1, 2018. Results: Twenty participants were included in the final analysis. The median age was 36 years, 14 (70%) were female, 13 (65%) were pharmacy technicians, and each study site had equal representation. Most participants, 15 (75%), had previously completed the standard MS training. There was a significant improvement in number of correct responses after the intervention with a prequestionnaire score of 61.3% to postquestionnaire score of 70% (P=.002). Significant improvement in knowledge was seen in participants who completed the previous training as well as first-time learners of the MS process. Conclusion: Optimizing training on MS processes by decreasing extraneous and intrinsic load improved the pharmacy team's knowledge and understanding of the MS process.

Community-Based Pharmacy Travel Health Service Pilot Impact on Participant Understanding and Satisfaction.

BACKGROUND: Increased rates of international travel have led to a higher demand for healthcare professionals to provide travel health services. Community-based pharmacists are capable of meeting this need. OBJECTIVE: This study evaluates the impact of pharmacists providing travel health services in a community-based pharmacy on participant understanding and satisfaction of travel education and preparation. METHOD: A trained pharmacist met with participants to review their medical history, travel itinerary, and provide education. Indicated immunizations were administered and the participant's primary care provider was contacted if prescription medications were warranted. A questionnaire was administered before and after the travel health consultation assessing participants perceived understanding of travel health information, satisfaction, and perceived monetary value of the service. Data were collected by 5-point Likert-scale responses, with 5 equivalent to strongly agree. Wilcoxon signed-rank test and descriptive statistics were used for evaluation. Participants were included if they had international travel planned within 12 weeks of the consultation. RESULTS: A total of 12 participants were included. Participant understanding significantly increased for all 5 survey items relating to travel health information with a p value < 0.05 for each item. The largest change was for how to find medical help during international travel (medians and IQR were 3(2-3), and 5(5-5) for pre-and post-consultation, respectively, p = 0.003). Participant satisfaction questions received a median response of 5. Participants' perceived monetary value of the service was a median of $50 (IQR $50-50). CONCLUSION: Pharmacist-led travel health consultations improved participant understanding of travel health information and was of perceived value.

Implementation and evaluation of simulations in a required course to improve empathy of pharmacy students.

INTRODUCTION: It is essential for health care professionals to display empathy when communicating with patients. Therefore, empathy is an important skill to teach health care professional students. The objective of this study was to examine the effect of a course enhancement consisting of formal instruction and application-based simulations on empathy in pharmacy students. METHODS: The Jefferson Scale of Empathy for Health Profession Students (JSE-HPS) was administered at the start of the semester and again at the end of the 16-week required course for third-year pharmacy students. Differences in the mean scores were analyzed using a paired t-test. An inductive conventional content analysis approach was utilized to analyze end of the course reflections about empathy by two investigators. RESULTS: On the pre-survey (n = 140), the empathy scores ranged from 86 to 140 (mean 113.8). On the postsurvey (n = 73), scores ranged from 93 to 137 (mean 117.5). A statistically significant increase in students' empathy scores on the JSE-HPS was observed following the completion of the course (P = .006). The main themes that emerged from the students' reflections were the impact of empathy on patient-centered care and the importance of patient-provider relationships. Students also discussed the development and use of empathy skills. CONCLUSIONS: A combination of didactic and skills-based training led to an improvement in empathy in third-year pharmacy students. Student comments highlighted the value of practicing empathy skills in a simulated environment.

Impact of Automated Notifications on Prescription Abandonment.

BACKGROUND: Prescription abandonment impacts patients' quality of life and disease progression. In addition, prescription abandonment can increase total healthcare costs. OBJECTIVE: This study compared effects of automated telephone calls (ATC), automated text messages (ATM), and control on prescription abandonment rates with Medicare defined Star Rated medications. The secondary objective compared prescription abandonment rates between age groups (18-64 versus ≥ 65 years) within each arm. METHODS: This was a retrospective observational analysis from a regional division of a large community-based pharmacy chain. Star Rated medication prescriptions consisting of hydroxymethylglutaryl-coenzyme A reductase inhibitors, renin-angiotensin system antagonists, and non-insulin type 2 diabetes mellitus medications were included. Prescriptions for patients who activated or deactivated automated notification enrollment during the study period were excluded. RESULTS: A total of 31,056, 33,278, and 20,299 prescriptions were included in the analysis of ATC, ATM, and control arms, respectively. Prescription abandonment occurred on 726 (2.3%) prescriptions within ATC arm, 864 (2.6%) prescriptions within ATM arm, and 513 (2.5%) prescriptions within control arm (p = 0.099). Prescription abandonment occurred on 390 (2.6%) prescriptions for 18-64 and 336 (2.1%) prescriptions for 65 years or older within the ATC arm (p = 0.002). Prescription abandonment occurred on 251 (2.9%) prescriptions for 18-64 and 262 (2.3%) prescriptions for 65 years or older within the control arm (p = 0.006). CONCLUSION: No difference in rates of prescription abandonment existed between each automated notification arm on Star Rated medications. ATC notifications decreased rates of prescription abandonment when utilized by patients 65 years or older.

Incidence of Acute Kidney Injury Among Patients Receiving the Combination of Vancomycin with Piperacillin-Tazobactam or Meropenem.

INTRODUCTION: Vancomycin (VAN) is associated with an increased risk of acute kidney injury (AKI). Evidence is conflicting regarding the risk of AKI when VAN is combined with an antipseudomonal ß-lactam. OBJECTIVES: To determine the comparative incidence of AKI when VAN is combined with piperacillin-tazobactam (PTZ) or meropenem (MER). METHODS: This was a retrospective cohort study of acutely ill adults receiving the combination of VAN and PTZ or MER for at least 48 hours between November 1, 2014, and October 31, 2016, in a tertiary care hospital. Critically ill patients and those with baseline renal dysfunction were excluded. The primary outcome was the incidence of AKI during or within 72 hours of completing antibiotic therapy, defined as an absolute increase in serum creatinine (Scr ) of 0.5 mg/dl or higher or a 50% or more increase in Scr from baseline. Secondary outcomes included time to AKI development, duration of AKI, and length of hospitalization. Continuous variables were assessed using the Wilcoxon rank sum or the Student t test; categorical variables were assessed using χ2 or Fisher exact tests. Independent risk factors for the development of AKI were also examined. RESULTS: A total of 169 patients were evaluated. A significantly higher incidence of AKI was observed in the PTZ group compared with MER (16.5% vs 3.6%; p=0.009). The median time to AKI onset was significantly shorter with PTZ compared with MER (3 vs 7 days; p=0.009). After adjusting for baseline differences, VAN/PTZ was associated with a 6.8-fold increased risk of developing AKI (odds ratio [OR] 6.8, 95% confidence interval [CI] 1.5-30.9) compared with VAN/MER. VAN doses higher than 4 g/day and trough levels higher than 20 µg/ml were independent risk factors for developing AKI (OR 8.7, 95% CI 1.04-72.94, and OR 9.01, 95% CI 1.44-56.21, respectively). CONCLUSION: The combination of VAN/PTZ increases the risk of AKI when compared with VAN/MER in acutely ill adults.