Development and curricular alignment of a pharmacy travel medicine elective.

BACKGROUND AND PURPOSE: Describe the design, implementation, and value of a travel medicine pharmacy elective. Students translated skills from rotations and practice environments addressing travel health-related needs. Content and educational outcomes align with the Center for the Advancement of Pharmacy Education, American Association of Colleges of Pharmacy, and Pharmacists' Patient Care Process core components of student learning and assessment. EDUCATIONAL ACTIVITY AND SETTING: A two-credit travel medicine elective included live and pre-recorded lectures, self-learning modules, peer critiques, and patient engagement. Students shadowed in a travel health clinic interacting with patients to prepare a formal travel care plan unique to the patient's history and travel destination. Pre- and post-course surveys, quizzes, progressive assignments, and course evaluations provided the framework for curricular enhancement. FINDINGS: A cohort of 32 third-year students provided evidence of successful curricular integration. Pre-course surveys demonstrated 87% of students self-scored low knowledge and ability to apply travel health services. Ninety percent of post-course surveys reported high levels of knowledge and ability. High perceived value was evident in course evaluations with some student intent to pursue credentialing. SUMMARY: Community practice affords increased opportunities to identify patients in need of travel medicine services. The unique approach and design supported successful integration of a travel medicine elective in the University of South Florida Taneja College of Pharmacy curriculum. Upon elective completion, students were prepared to educate internationally traveling patients to safely self-manage chronic health conditions, reduce potential health risks and harm exposures during travel, and monitor health changes upon return.

Ambulatory Care Pharmacists' Perception of Prediabetes.

INTRODUCTION: Eighty-four million patients in the United States have prediabetes yet evidence-based interventions to prevent diabetes are infrequently used. The concept of prediabetes is contentious, although preventive interventions are guideline supported. Team-based care models incorporating pharmacists for prediabetes have been proposed; however, pharmacist perception regarding prediabetes has not been assessed. This study's objective was to assess ambulatory care pharmacists' perception of recommendations for prediabetes. METHODS: An anonymous survey was electronically distributed through the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network. The primary outcome was the proportion of respondents who reported supporting 3 main recommendations related to prediabetes (ie, screening, evidence-based lifestyle-intervention, metformin). The study was approved by the University of South Florida Institutional Review Board. Data collection and analysis occurred in 2017. RESULTS: The survey was distributed to approximately 2209 potential participants. One hundred thirty-three surveys were completed. The American Diabetes Association guideline was the most common primarily supported guideline related to prediabetes (89%). Of the respondents, 87% supported all 3 main recommendations regarding prediabetes. Qualitative feedback demonstrated the full range of opinions; programs for prediabetes, limited intervention for prediabetes, and against prediabetes as a concept. CONCLUSIONS: The majority of ambulatory care pharmacists responding supported all main recommendations related to prediabetes and therefore may be practicable for disseminating diabetes prevention interventions. However, barriers to implementation should be expected.

Hepatitis C Virus Infection Screening Within Community Health Centers.

CONTEXT: Approximately 2.7 million people in the United States currently live with chronic hepatitis C virus (HCV) infection, and many are unaware that they have the disease. Community health centers (CHCs) serve as the primary care safety net for more than 22 million patients who are at risk for health inequities and represent an important frontline resource for early screening and treatment for HCV infection. OBJECTIVE: To understand HCV infection screening rates among CHC patients, and to quantify the screening gap by demographic characteristics. METHODS: The authors analyzed a deidentified dataset obtained through electronic health records from a large national network of CHCs. All adults at risk for HCV infection, according to the US Preventive Services Task Force (USPSTF) birth cohort screening guidelines for HCV infection, were considered eligible if they had a patient office visit between January 1, 2013, and December 31, 2013. Data were reviewed to determine the documentation of HCV infection screening from January 1, 2010, to December 31, 2013, and HCV infection screening rates were analyzed by age, race/ethnicity, and sex. RESULTS: Among 60,722 eligible patients, 5033 (8.3%) had an HCV infection screen in accordance with USPSTF birth cohort screening guidelines. Women were less likely to be screened than men in every race/ethnic group, including white Hispanic (9.3% in women vs 5.4% in men), black Hispanic (15.1% in women vs 9.0% in men), white non-Hispanic (13.6% in women vs 8.1% in men), black non-Hispanic (14.9% in women vs 8.9% in men), Caribbean Islander or Haitian (6.5% in women vs 3.7% in men), and other races/ethnicities (6.3% in women vs 3.6% in men). CONCLUSION: To the authors' knowledge, this is the first large-scale study among CHCs to assess the screening gap of the USPSTF birth cohort screening guidelines for HCV infection. This study suggests that CHCs should consider opportunities to improve HCV infection screening, thereby contributing to the reduction of health inequities resulting from untreated HCV infection.

Identifying opportunities in EHR to improve the quality of antibiotic allergy data.

BACKGROUND: Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics. METHODS: Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed. RESULTS: Among patients, 9.1% (n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR. CONCLUSIONS: Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients' records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated.

Synthetic cathinones (bath salts): legal status and patterns of abuse.

OBJECTIVE: To review the current legal status and patterns of abuse of bath salts. DATA SOURCES: A literature search was conducted through MEDLINE (1950-December 2011), PubMed (1966-December 2011), EMBASE (1966-December 2011), and International Pharmaceutical Abstracts (1970-December 2011) using the search terms bath salts, mephedrone, and methylenedioxypyrovalerone to identify articles on the legal status of bath salts and on studies focusing on patterns of abuse of bath salts. The GovTrack.us Web site was searched to determine the status of federal bills regarding bath salts. The National Association of Boards of Pharmacy and Drug Enforcement Administration Web sites and the Federal Register were also examined to identify legislation on bath salts. STUDY SELECTION AND DATA EXTRACTION: Case reports and studies regarding bath salts were examined. Federal laws involving bath salts were also evaluated. DATA SYNTHESIS: The Department of Justice issued a final order in the Federal Register, temporarily placing the 3 synthetic stimulants, mephedrone, methylenedioxypyrovalerone, and methylone, under Schedule I of the Controlled Substances Act. Literature evaluated included case reports, retrospective studies, surveys, toxicology data, and chemical analyses studies. Information in the literature demonstrated that bath salts are highly abused, and common adverse effects include hypertension, tachycardia, and psychiatric symptoms. CONCLUSIONS: Psychoactive substances recently sold as bath salts have been placed in Schedule I of the Controlled Substances Act. Pharmacists can play an important role in raising awareness on the dangers of bath salts abuse through patient counseling and community outreach programs. The evidence on legal status and patterns of abuse clearly demonstrates that bath salts contain dangerous substances that should be permanently controlled.

Evaluation of adverse drug event information in US manufacturer labels.

Pharmaceutical manufacturer labels are an important source of adverse drug event (ADE) information. The study objective was to determine the sufficiency of ADE reporting in US drug labels. A sample of 50 labels was evaluated from the top 200 drugs dispensed in the US. Electronic copies of labels were obtained and reviewed by 2 pharmacists for ADE incidence and discontinuation data. ADE incidence data were provided in 86% of labels. However, discontinuation rates due to ADEs and ADE incidence by dose were only reported in 60%. ADE incidence reporting by age (46%) or gender (18%) was also low. ADEs that occurred in less than 2% of the population were rarely reported. Incidence rates were based on small populations (median of 794) and short term studies (median of 84 days for chronic conditions). Labels for 19 drugs used chronically had no long term study data. Methods for collecting ADE data were stated in only 12% of labels. Adverse drug event and drug discontinuation data is under-reported in US labels. More information on adverse events causing discontinuation (especially serious events) and those related to dose, age, and gender is needed in labels to ensure safe prescribing and dispensing of drugs.

The impact of student-faculty ratio on pharmacy faculty scholarship.

OBJECTIVE: To determine the relationship and impact of student-faculty ratio on scholarship of pharmacy faculty members. METHODS: The number and rank of faculty members, pharmacy program characteristics, and faculty productivity data were collected to determine the impact of student-faculty ratio on faculty scholarship. RESULTS: Faculty scholarship was not predicted by student-faculty ratio. Factors impacting positively on faculty productivity included National Institutes of Health funding; presence of clinical associate professors, instructors, and lecturers; and programs located in public universities. CONCLUSIONS: Faculty productivity is not related to the student-faculty ratio, wherein more faculty members and fewer students equates to increased scholarship. However, public universities may have different infrastructures which are associated with greater academic productivity compared to private institutions. Additionally, utilizing instructors and clinical or nontenure-track faculty members can significantly increase scholarship among faculty members.