Antipsychotics in child and adolescent patients with major depressive disorder: A retrospective analysis of prescribing patterns.

Introduction: Depression rates in children/adolescents in the United States have increased in the last 10 years. Fluoxetine and escitalopram are the only 2 antidepressants approved for the treatment of major depression disorder (MDD) in children/adolescents. In adults, some antipsychotics are approved for augmented treatment of MDD. However, there is limited research on antipsychotic augmentation in child/adolescent MDD. Methods: This retrospective chart review evaluated antipsychotic prescribing for MDD in hospitalized patients aged 4 to 17 years to determine the frequency of prescribing antipsychotics for MDD and what factors influence the addition of an antipsychotic. For inclusion, patients were diagnosed with MDD and not on an antidepressant or antipsychotic before admission. Binomial logistic regression was used to analyze variables with prescribed antipsychotics as the dependent variable. Results: There were 6.8% of patients prescribed an antipsychotic. Binomial logistic regression analysis found that increased age (odds ratio [OR] 1.28; 95% CI = 1.045, 1.568; P = .017) and multiple admissions within 1 year (OR 3.277; 95% CI = 2.283, 4.705; P < .001) were associated with the use of antipsychotics in patients with MDD. Posttraumatic stress disorder and disruptive mood dysregulation disorder were also associated with the use of antipsychotics. Discussion: Careful consideration should be taken when using off-label antipsychotics in children due to limited studies on efficacy. Future research is warranted to assess the efficacy and safety of these agents in children and adolescents.

Implementing pharmacist-led diabetic digital retina scan services at a federally qualified health center.

BACKGROUND: Due to low national and local rates for annual eye exams in patients with diabetes, a pharmacist-led chronic care clinic creates a unique opportunity for pharmacists to provide digital retina scans in the primary care setting. OBJECTIVES: The primary objective is to assess the impact of a pharmacist-led digital retina scan service on rates of annual eye exams among patients with diabetes. PRACTICE DESCRIPTION: KC CARE Health Center, a federally qualified health center in Kansas City, Missouri, offers healthcare services to any member of the community regardless of insurance status. Pharmacists work in this setting to assist with management of chronic disease under a collaborative practice agreement. PRACTICE INNOVATION: A pharmacist developed a workflow process to provide digital retina scans in the primary care setting for patients with diabetes who had not had an eye exam in the past 12 months. Images of each eye are captured using a RetinaVue 700 Imager and these images are submitted to an ophthalmologist for review. EVALUATION METHODS: Rates of annual eye exams among patients with diabetes seen in the primary care clinic before and after retina scan service implementation were analyzed using a chi-squared test with an a-priori alpha of 0.05. Survey data of patient-reported barriers to follow-up were reported using descriptive statistics. RESULTS: There was a 5% increase in the annual eye exam rate of patients with diabetes seen at the clinic during the study period. The increase in rate of annual eye exam from before the intervention to after was statistically significant (P < 0.001). CONCLUSION: Implementing a pharmacist-led retina scan program in the primary care setting improved the rate of annual diabetic eye exams and demonstrated the benefit that pharmacists can have in enhancing accessibility to preventative care services.

Consumer perception, knowledge, and uses of cannabidiol.

Introduction: The legalization of cannabidiol (CBD) across the United States, in varying degrees, has made CBD easily accessible to consumers for complementary and medical purposes. However, there is a paucity of scientific evidence on the benefits and risks of commercially available CBD. In the literature, 2 studies have gathered consumer perceptions and attitudes on cannabis products, specifically CBD, using survey-based questionnaires. This study aimed to build on the aforementioned studies in obtaining consumer perception and knowledge of CBD products using a national survey-based questionnaire. Methods: Respondents were recruited through an anonymous, nationwide, online survey administered through Qualtrics in the United States from March 28 to April 30, 2021. The survey consisted of demographics, perceived efficacy and safety of CBD, and resources to obtain CBD information. The survey responses were reported using descriptive statistics along with median and interquartile range for the Likert portion. Results: A total of 1158 respondents accessed the survey. The median age was 43 and 50% of respondents were female. The uses for CBD included neurological disorders, pulmonary conditions, gastrointestinal disorders, and chronic pain. The most commonly reported safety concern related to taking CBD was anxiety. Participants agreed that CBD is safe when used responsibly for medical use, and social media was the main source used to obtain information about CBD. Discussion: Respondents who used CBD for a condition thought it was helpful; however, most of the adverse effects were rated as moderate to severe, requiring medical attention from a health care professional, hospital, or emergency room visit.

Comparison of inpatient psychiatric medication management in gender diverse youth with cisgender peers.

Introduction: The primary objective was to determine if gender diverse (GD) youth receive different psychotropic prescribing compared with cisgender (CG) peers with the same diagnosis. Secondary objectives include evaluation of readmission rates and the effect of gender-affirming hormone therapy (GAHT) on psychiatric outcomes in transgender (TG) patients. Methods: A total of 255 GD youth patients were retrospectively matched to CG controls based on age, primary discharge diagnosis, and year of admission. Data collection included psychotropic medications at admission and discharge, baseline demographics, time to readmission, and total number of readmissions within 6 months. Use of GAHT was also documented. Wilcoxon signed rank test was used for continuous and χ2 for nominal data with an a priori α of 0.05. Results: MDD was the primary discharge diagnosis in 74% of patients. GD youth were more likely to present on antidepressants (P = .031) and antipsychotics (P = .007), and to be discharged with antipsychotics (P = .003). They were additionally more likely to be readmitted within 30 days of discharge (P = .032). TG youth on GAHT (13%) had fewer readmissions (P = .046) than those not on GAHT, but there were no differences in psychotropic prescribing. Discussion: Higher antipsychotic and antidepressant prescribing were seen in the GD population despite the same mental health diagnosis. Despite higher prescribing in the GD population, patients presented for readmission within 30 days more frequently, which may represent a need for more rigorous transitions-of-care practices in this population.

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.

Impact of state mandates on electronic prescribing of acute opioid prescriptions for the treatment of pain in Kansas and Colorado.

BACKGROUND: Government and health care entities are seeking solutions to optimize safe opioid prescribing practices. Electronic prescribing of controlled substance (EPCS) state mandates are becoming common, but lack thorough evaluation. OBJECTIVE: This study aimed to evaluate whether EPCS state mandates affect opioid prescribing patterns for acute pain treatment. METHODS: This retrospective study was designed to assess prescribing patterns via percent change for quantity, day supply, and prevalence of prescribing method utilized for opioid prescriptions 3 months pre- and post-EPCS mandate. Prescription data are extracted from two regional divisions of a large community-based pharmacy chain between April 1, 2021 to October 1, 2021. Relationships of patient geographical locations and prescribing methods were assessed. Likewise, the relationship of opioids prescribed between insurance types were evaluated. Data was evaluated utilizing Chi-Square and Mann-Whitney U tests, with an a-priori alpha of 0.05. RESULTS: There was an increase before to after state mandate of quantity and day supply (0.8% and 1.3% [P = 0.02; P < 0.001], respectively). There were significant decreases in total daily dose and daily morphine milligram equivalent (2.0% and 1.9% [P < 001; P = 0.254], respectively). A 16.3% increase was seen in electronic prescribing before to after state mandate for prevalence of electronic prescribing versus other prescribing methods. CONCLUSION: There is a correlation between EPCS and prescribing patterns for acute pain treatment with opioids. The use of electronic prescribing increased after state mandate. By promoting the use of electronic prescribing, the benefit of awareness and caution of opioid use draws attention to prescribers.

Assessing the effects of pharmacist education on colorectal cancer screening and access to a stool-based DNA test.

BACKGROUND: Colorectal cancer is the third most common cancer and is anticipated to cause 52,580 deaths in 2022 in the United States. Despite the effectiveness of colorectal cancer screening (CRCS), only 74% of adults eligible for CRCS complete the screening. Community pharmacists are well positioned to provide preventive care education and recommendations to the general population. OBJECTIVES: This study aimed to evaluate overall participants' knowledge, perceptions, and barriers on CRCS before and after receiving pharmacist-led education in the outpatient, community pharmacy setting and to assess the impact of pharmacist intervention on screening uptake with the stool-based DNA test. METHODS: A 16-item prequestionnaire/postquestionnaire was administered by clinical pharmacists in a grocery store pharmacy chain in the Kansas City area. The questionnaire assessed participants' knowledge, perceptions, barriers, CRCS intentions, and demographics. After completing the prequestionnaire, participants received verbal and written education. For those participants interested in the stool-based DNA test, a facsimile transmission was sent to the participant's provider. The postquestionnaire was administered by the pharmacist coach at visit two 6 to 10 weeks later. Participant demographics were assessed using descriptive statistics. Wilcoxon signed rank test was used to assess prechanges/postchanges in perceptions, awareness, and knowledge. We reported the stool-based DNA test completion rate as an overall percentage. RESULTS: Participants' knowledge of CRCS reached statistical significance after pharmacist-led education (score 4.5-6, P = 0.003). There was no change in perception pre/post. The 3 most common reported barriers were cost of screening, not being concerned with colon cancer, and lack of follow-up from a physician. Of 42 participants, 23 (54.8%) were indicated for CRCS and 4 (17%) completed screening during the study. CONCLUSION: Not all eligible participants completed CRCS, but pharmacists improved participants' knowledge of CRCS.

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.

Initiation of Antipsychotic Treatment for Amphetamine Induced Psychosis and Its Impact on Length of Stay.

Introduction: A risk of amphetamine use is amphetamine-induced psychosis (AIP). Symptoms of AIP include hallucinations, delusions, and agitation. While AIP may resolve with abstinence from amphetamines, antipsychotics are commonly used despite not being FDA approved. The primary objective of this study was to compare length of stay (LOS) for patients with AIP treated with antipsychotics vs untreated. Secondary aims were to determine antipsychotic prescribed, proportion of patients utilizing as needed doses, time to initiation, and readmissions. Methods: A retrospective chart review conducted at an academic medical center identified adult participants who were diagnosed with AIP, admitted to inpatient psychiatry service, and had a urine drug screen (UDS) positive for amphetamines. Patients were excluded if they were already taking an antipsychotic, had active prescriptions for amphetamine salts, or were in the emergency department for more than 48 hours. Demographics were assessed with descriptive statistics. Length of stay was compared between treatment groups using Kruskal-Wallis. Secondary aims were assessed using chi-square, Mann-Whitney U, and Kruskal-Wallis. Results: Sixty-nine patients were included. Median LOS for patients treated with antipsychotics (n = 35) was longer than untreated patients (n = 34), (5 days vs 2.5 days, P = .001). Type of antipsychotic used and time to initiation of antipsychotic were not found to affect LOS. There was no difference in readmissions rates and positive UDS on readmission between groups. Conclusion: This study found patients with scheduled antipsychotics for AIP had a longer LOS than patients who did not receive scheduled antipsychotics. Future studies are needed to evaluate antipsychotic use in AIP.

Assessing the impact of a pharmacy-provided personalized vaccination recommendation on immunization rates of adolescents.

BACKGROUND: Adolescents should receive timely doses of recommended vaccinations. The coronavirus disease 2019 (COVID-19) vaccination approval for adolescents presented an opportunity for community pharmacists to address gaps in adolescent immunization schedules. OBJECTIVES: The objectives of this research were to (1) identify adolescent immunization gaps, (2) identify number of patients receiving recommended vaccination(s) at the community pharmacy, and (3) determine how many vaccinations were administered after the intervention. METHODS: Three pharmacies conducted the prospective intervention. Adolescents aged 11-17 years initiating the Pfizer-BioNTech COVID-19 vaccination series were eligible to receive a personalized vaccination recommendation (PVR), which included up to 3 other vaccinations. State immunization information systems were assessed after dose 1 of the COVID-19 vaccine to create the recommendation(s) and reassessed 6 months after providing the PVR for accepted recommendations. Patient demographics and number of vaccinations administered were assessed using descriptive statistics. RESULTS: Of the 225 adolescents who received COVID-19 vaccine dose 1, 74.7%, 75.1%, and 83.1% were indicated to receive tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal conjugate (MenACWY), or human papillomavirus (HPV) vaccine, respectively. Thirty-three (14.7%) adolescents were up to date on all 3 vaccinations assessed. Of the 225 adolescents, 180 returned to the same location for COVID-19 vaccine dose 2 and received a PVR. Forty-two caregivers reported that their adolescent previously received 1 or more of the recommended vaccinations, indicating that state immunization information systems were inaccurate. Six months after the PVRs were given, 24 vaccinations had been administered. CONCLUSIONS: Most adolescents presenting for a COVID-19 vaccine were indicated, according to state immunization information systems, to receive at least 1 additional vaccination. After pharmacist-provided PVR and education, vaccine uptake occurred. Considering caregiver-reported inaccuracies, pharmacists should be cognizant of potential discrepancies when providing PVRs. In addition, this study highlights the value of a state immunization information system.

Semaglutide Initiation in a Type 2 Diabetes Mellitus, Post-Liver Transplant Patient.

Objective To describe the process of initiation of semaglutide for complex management of type 2 diabetes mellitus (T2DM) in a patient after liver transplantation. Setting Family medicine clinic. Practice Description A family medicine clinic comprising six physicians with an ambulatory care pharmacist. The pharmacist has direct interaction with patients and providers within the clinic assisting in the management of chronic disease states under a collaborative practice agreement. Practice Innovation A 63-year-old White male with a history of liver transplantation in the context of T2DM, treated with basal-bolus insulin therapy, was referred by his family medicine provider to the ambulatory care pharmacist for diabetes management because of a hemoglobin A1c (HbA1c) level greater than 10%. Semaglutide was initiated and titrated to improve blood glucose control in combination with basal-bolus insulin adjustments taking disease states, cost, and health literacy into consideration. Results The addition of semaglutide, over an eight-month period, assisted with glycemic control to an HbA1c of less than 7%. Conclusion Semaglutide, in addition to basal-bolus insulin therapy, allowed for overall improved glycemic control; however, further studies are needed to evaluate efficacy because of the complexity of diabetes management in this patient population. Throughout the course of treatment of patients with T2DM and organ transplantation, dual monitoring of antidiabetic therapy and antirejection medications is essential to reduce the risk of organ rejection.

Vaccination approval literacy and its effects on intention to receive future COVID-19 immunization.

BACKGROUND: Before the coronavirus disease 2019 (COVID-19) vaccine release, polls showed only 50% of Americans had intention to receive the COVID-19 vaccine. The vaccine hesitancy may result from a lack of confidence in vaccine safety and efficacy. More research is needed to identify whether knowledge of vaccine approval processes relates to vaccination intentions. OBJECTIVES: The objectives of this study were to (1) evaluate participants' knowledge regarding COVID-19 and vaccine approval processes, (2) evaluate participants' intentions to receive the COVID-19 vaccine, and (3) compare participants' knowledge assessment results with COVID-19 vaccine intentions. METHODS: A prospective, cross-sectional questionnaire was administered to patients participating in a pharmacist-led chronic disease state management program. The 22-item questionnaire assessed demographic information and evaluated the participant's knowledge and vaccine intentions. Data were analyzed with an a priori alpha value of 0.05. RESULTS: Nearly all participants answered correctly on questions pertaining to COVID-19 infection (n = 92, 93%), COVID-19 symptoms (n = 96, 96%), and the Food and Drug Administration's roles in vaccine approval processes (n = 92, 92%). Participants scored lower on questions involving the differing requirements between clinical trial phases (n = 20, 21%) and vaccine safety in the United States (n = 51, 53%). Most participants (n = 54, 55.1%) did not believe the trials were taking too long to produce a vaccine, but 40.4% of the participants (n = 40) believed the vaccine was approved too quickly. More than half of the participants (n = 55, 56.1%) desired more information on how vaccines get approved in the United States. Participants who scored higher on the knowledge assessment were more likely to have a plan to receive the vaccine (P = 0.008). CONCLUSIONS: The results of this study demonstrate the influence knowledge has on intentions to receive vaccines and may aid health care providers in their attempts to promote vaccinations.

Veterinary prescription errors in a community pharmacy setting: A retrospective review.

BACKGROUND: Community pharmacies are poised to see more veterinary prescriptions as a result of increased pet ownership especially during the coronavirus disease 19 pandemic. Concern has been raised about the lack of veterinary pharmacy training that community pharmacists receive, but no studies have evaluated the actual prevalence of errors in veterinary prescriptions including the prevalence of prescription writing errors. OBJECTIVES: This study identifies the prevalence of errors in veterinary prescriptions at independent community pharmacies. METHODS: An electronic form was used to ensure required information was pulled from the pharmacy software systems in a consistent manner. Information was pulled from the hard copy image and the prescription label corresponding to that fill. Prescribing trends, such as species and errors, were assessed using descriptive statistics for the overall sample. Error comparisons between written and verbal prescriptions and between weight-based and nonweight-based prescriptions were assessed using chi-square and Fisher exact tests. RESULTS: Weight, although not legally required but clinically necessary for evaluation of veterinary prescriptions, was omitted from 97.8% of prescriptions. When evaluating the prevalence of errors between handwritten and verbal prescriptions, it was more likely to see errors in prescriptions handwritten by the veterinarian (105 of 119; 88%) than verbal prescriptions (257 of 389; 66%). Conversely, handwritten prescriptions were less likely to omit the required Drug Enforcement Agency number on controlled substance prescriptions. CONCLUSION: Based on the number of errors seen in both handwritten and verbal prescriptions, emphasis should be placed on training pharmacists to be competent in clinically evaluating veterinary prescriptions and training veterinarians on handwriting prescriptions to include both legally and clinically required information needed before dispensing.

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.

Assessing pharmacy students' knowledge and perceptions of urine drug testing following a pharmacy skills laboratory.

INTRODUCTION: Urine drug tests (UDTs) are commonly used in the healthcare setting to monitor adherence, abuse, and diversion of controlled substances. The goal of our study was to assess the knowledge and perceptions of third-year pharmacy students on UDTs following an educational experience. METHODS: Third-year pharmacy students completed pre- and post-questionnaires following a skills laboratory focused on the use of UDTs in clinical settings. The 34-item questionnaires consisted of three domains: demographics, knowledge regarding UDTs, and personal perceptions of UDTs. A pre-lab teaching podcast was assigned prior to the laboratory session, and two clinical cases were discussed during the live UDT segment. Descriptive statistics were used to assess demographics, and changes in knowledge and perceptions of UDTs were evaluated using chi-square and Mann-Whitney U, respectively, with an a priori alpha of 0.05. RESULTS: One hundred twenty students were included in the analysis. Students in the laboratory were predominately female (n = 72, 60%), Caucasian (n = 84, 70%), and had no prior training with UDTs (n = 104, 86.7%). Student knowledge of UDT interpretation significantly increased from 57% to 71% (four and five correct answers out of seven, respectively). Confidence interpreting UDTs and answering questions related to UDTs also increased significantly. Students felt the laboratory experience was valuable, with 84.2% agreeing or strongly agreeing. CONCLUSIONS: Educational programming focused on UDTs improves student confidence interpreting results and knowledge related to the use of UDTs.

Patient Knowledge and Experiences With Antibiotic Use and Delayed Antibiotic Prescribing in the Outpatient Setting.

BACKGROUND: Most antibiotic prescriptions originate in the outpatient setting and an estimated 30% are unnecessary. Pharmacists are well positioned to positively impact antibiotic prescribing habits; the role of the community pharmacist in outpatient antibiotic stewardship programs is not well defined. OBJECTIVES: The objectives of this study were to (1) assess the knowledge of the general public regarding appropriate antibiotic use, and (2) assess the experiences of the general public regarding delayed antibiotic prescriptions. METHODS: A cross-sectional survey was administered at community pharmacies in Kansas from September 2018 to January 2019. Eligible individuals were older than 18 years and self-reported their ability to speak and read English. The 22-item survey collected demographics, knowledge regarding appropriate antibiotic use, and participant understanding and experiences of delayed antibiotic prescribing. Descriptive statistics assessed demographics and chi-square compared responses between demographics. RESULTS: Of 347 surveys completed, respondents were mainly Caucasian (91.6%), female (58.2%), and aged 60 years or older (59.1%). Those with high school education or below were more likely to believe antibiotics kill viruses (43.1% vs 20.9%, respectively; p < 0.01) and that antibiotics work on most coughs and colds (31.4% vs 16.2%, respectively; p = 0.01). Delayed antibiotic prescriptions were more frequently offered to those who had received an antibiotic prescription in the last year compared to those who had not (36.1% vs 15%, p < 0.001). CONCLUSION: Gaps in patient knowledge about appropriate antibiotic use and delayed prescribing present an opportunity for community pharmacists to educate patients and become involved in outpatient antibiotic stewardship.

The effect of age and gender on acute postoperative pain and function following lumbar spine surgeries.

BACKGROUND AND PURPOSE: Understanding the factors contributing to the variability in postoperative pain and function following lumbar spine surgeries (LSS) is necessary to plan inpatient rehabilitation and optimize surgical outcomes. In particular, variability due to age and gender has not been studied. This study's aim was to evaluate the variability in postoperative pain and function, during hospital stay, due to age and gender following LSS. METHODS: We conducted a retrospective analysis of 585 patients who underwent LSS during their hospital stay. Univariate ANCOVA was performed to study the differences in postoperative pain, and multivariate ANCOVA was performed to study the differences in postoperative function (gait distance, independency combined score, and balance combined score) between age groups (older adults [≥65 years of age] vs. younger adults) and gender. RESULTS: Younger patients reported statistically, but not clinically, significant higher postoperative pain than older patients (ß = 0.652 [95% CI (0.382-0.986)], p < 0.001), and males reported statistically, but not clinically, significant lower postoperative pain than female patients (ß = -0.583 [95% CI (-0.825 to -0.252)], p < 0.001) with adjustment of covariates. Male patients walked significantly longer distance than female patients (ß = 0.272 [95% CI (0.112-0.432)], p = 0.001) with adjustment of covariates. However, these were clinically insignificant. With adjustment of preoperative diagnosis, type of surgery, severity of illness, and prior level of function, there was no statistically significant difference between age groups in walking distance, and between age and gender groups in independency combined score and balance combined scores. DISCUSSION: Following LSS, the difference in postoperative pain between age groups and gender are statistically but not clinically significant, suggesting patients require similar effective postoperative pain management regardless of age and gender. The apparent difference in age and gender in postoperative functional outcomes could be due to other factors.

Pharmacist impact on medication dosing and billable coding accuracy in outpatients with chronic kidney disease.

BACKGROUND: Ambulatory care pharmacists can enhance economic and clinical outcomes as part of interdisciplinary health care teams. Patients with chronic kidney disease (CKD) often have complex medication regimens, potentially resulting in dosing errors and drug interactions. OBJECTIVE: To demonstrate the impact that clinic-based pharmacists may have in populations comprising ambulatory patients with CKD. PRACTICE DESCRIPTION: Community-owned, not-for-profit health system with outpatient, primary, and specialty care clinics. PRACTICE INNOVATION: This quality-assurance, cohort, interventional study included patients aged at least 18 years with a CKD- or end-stage renal disease-associated diagnosis code seen by a clinic primary care provider at least once between January and June 2019. Primary outcomes included the number of medications requiring pharmacist intervention, pharmacist-initiated recommendations, and associated outcomes. EVALUATION METHODS: Patients were randomly assigned to 2 cohorts. Providers of patients in the proactive pharmacist intervention group were notified of pharmacist recommendations immediately after initial data collection. Providers of patients in the group undergoing usual care (control group) were notified of identified medication recommendations after a 3-month period of usual care. Demographics were assessed using descriptive statistics. Differences in CKD staging, number of recommendations made, and provider responses were assessed using the chi-square, Fisher exact, and Mann-Whitney U tests. RESULTS: A total of 182 patients were eligible for inclusion. In the intervention group, 22.1% of patients were identified as having inappropriately dosed medications versus 19.5% in the control group. In the intervention group, 46 of the 95 patients (48.4%) had an inaccurate CKD stage documented compared with 48 of the 87 patients (55.2%) in the control group (P = 0.772). The rate of pharmacist recommendation rejection substantially decreased between the intervention and control groups' provider responses (24% to 11.8%). CONCLUSION: Pharmacist-initiated recommendations resulted in the identification and resolution of medication-dosing errors and improved collaboration between providers and pharmacists.

Public awareness of Mental Health First Aid and perception of community pharmacists as Mental Health First Aid providers.

OBJECTIVES: The objectives of this study were to (1) identify the number of participants who screened positive for major depressive disorder, (2) assess the number of participants who have discussed or would like to discuss mental illness with a trained professional, (3) determine public awareness about Mental Health First Aid (MHFA), and (4) determine public perception regarding community pharmacists trained in MHFA. METHODS: A cross-sectional survey was administered at community pharmacies to participants aged 18 years and older who were able to speak and read in English. The 18-question survey was used to screen for major depressive disorder using the Patient Health Questionnaire-2 (PHQ-2) and to collect demographic information, mental health diagnoses, beliefs regarding current mental illness and treatment, desire and history of talking with a trained professional about mental illness, and MHFA awareness. In addition, data on comfortability talking to a pharmacist about mental illness was collected. Data were analyzed with an a priori α of 0.05. RESULTS: A total of 358 surveys were collected. Seven participants (2%) screened positive for depression using PHQ-2. One hundred eight participants (30.4%) reported a previous desire to speak to someone about mental illness; of these, only 41 (38.7%) and 63 patients (59.4%) reported speaking to a physician or therapist, respectively. Only 53 participants (15.4%) reported awareness of MHFA. Participants reported a higher level of comfortability (P < 0.01) speaking about mental illness with an MHFA-trained pharmacist. Similarly, participants more strongly agreed (P < 0.01) that pharmacists are qualified to discuss mental illness if trained in MHFA. Most participants believed pharmacists should be trained in MHFA (n = 260, 68.2%). CONCLUSION: Participants indicated comfortability discussing mental illness with community pharmacists trained in MHFA, revealing an opportunity for pharmacists to expand access to mental health services by being trained in MHFA and counseling about mental illness.