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.

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.

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.

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.

Comparing patients' prescribed, self-reported, and actual intake of supplemental eicosapentaenoic acid + docosahexaenoic acid.

BACKGROUND: Dietary fish oil supplements containing the omega-3 polyunsaturated fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are frequently used for cardiovascular benefit. However, several factors may limit the intake of prescribed doses. OBJECTIVE: The objective of this study is to compare the prescribed, patient self-reported, and actual intake of supplemental EPA + DHA doses in a lipid-specialty clinic and identify common barriers and influences to therapy. METHODS: Seventy-six patients prescribed supplemental fish oil were randomly selected to participate in a 28-item cross-sectional survey for evaluating patient knowledge and intake of prescribed supplemental EPA + DHA doses. Self-reported data were collected during a follow-up clinic visit, whereas actual intake was determined when patients had access to their fish oil bottle. These data were compared with their chart-documented prescribed EPA + DHA dose. RESULTS: Many patients were well-educated and had attended the lipid-specialty clinic for approximately 2 years but only 28.9% were confident that they could accurately recall their daily EPA + DHA dose. There were statistically significant differences between the prescribed doses and patients' self-reported doses (3600 mg vs 2750 mg, P = .014), as well as between prescribed doses and actual intake (3600 mg vs 1575 mg, P < .001). Patients reported multiple barriers and influences to explain their use of fish oil products. CONCLUSION: Most patients using supplemental fish oil in a lipid-specialty clinic were not taking the prescribed amount of EPA + DHA, with many using markedly lower than prescribed doses. This is likely because of several factors including the complexities of supplemental fish oil doses and labeling, product availability, and discount sales. These findings suggest that supplemental fish oil requires continuous education and dosing guidance.

Impact of community pharmacist intervention on concurrent benzodiazepine and opioid prescribing patterns.

OBJECTIVES: (1) To evaluate the number of opioid/benzodiazepine (BZD) prescription changes resulting from pharmacist communication to prescriber(s); (2) to determine the number of patients on concurrent opioid/BZD therapy from single versus multiple prescribers; (3) to compare the number of opioid/BZD prescription changes resulting from communication when a single versus multiple prescribers was involved in a patient's care; and (4) to compare the number of opioid/BZD prescription changes resulting from communication via fax versus the Kansas Health Information Network (KHIN) direct messaging feature. METHODS: Prospective study conducted at 13 community pharmacies, including patients 18 years of age or older simultaneously filling opioid and BZD prescriptions within 90 days before October 2017. Prescribers received faxed or KHIN communication proposing evidence-based prescription changes to opioid/BZD agents. Prescription changes were evaluated weekly for 3 months after the initial intervention. Descriptive statistics assessed demographics and the number and types of prescription changes. Spearman rho correlations compared prescription changes and number of prescriptions to number of prescribers; a priori alpha was set at 0.05. RESULTS: A total of 137 prescribers and 121 patients were included. Ninety-nine prescribers were contacted via fax and 38 via KHIN. After 4 weeks, 34 recommendations were received: 20 responses (59%) indicated rejection of recommendations, 5 (15%) approved BZD taper/discontinuation, 3 (9%) deferred changes until a patient visit, 2 (6%) approved opioid taper/discontinuation, 2 (6%) prescribed naloxone, and 2 (6%) withdrew from the patient's care. Three months after communication, 35 prescription changes were noted: 22 (63%) opioid/BZD agent tapers/discontinuation, 14 (26%) opioid/BZD dose increases, and 2 (6%) naloxone prescriptions. There was positive correlation between the number of tapered/discontinued agents and the number of prescribers involved in a patient's care (P = 0.046). CONCLUSION: A faxed pharmacist intervention may help to reduce opioid/BZD coprescribing, especially when multiple providers are involved in a patient's care.

Assessing pet owner and veterinarian perceptions of need for veterinary compounding services in a community pharmacy setting.

BACKGROUND: Pets, pet owners (referred to as clients in veterinary medicine and throughout this article), veterinarians, and community pharmacies may all benefit from veterinary compounding services provided in community pharmacies, but the benefits of this service are not well-documented in the literature. OBJECTIVES: This study identified perceived benefits and barriers and evaluated the need for veterinary compounding services in community pharmacies; it also evaluated current business practices related to veterinary compounding services. METHODS: A cross-sectional survey was administered to three groups: 1) clients who filled a pet prescription at a study pharmacy, 2) clients who had not filled pet prescriptions, and 3) local veterinarians. Eligible participants were 18 or older; clients must have owned a pet in the past five years. The surveys collected demographic information and assessed benefits, barriers, need, and business practices regarding veterinary compounding services. Demographics were evaluated through descriptive statistics. Responses to Likert-scale items were compared between groups using the Mann-Whitney U test. Qualitative responses were assessed for emerging themes. RESULTS: One hundred eighteen clients and 15 veterinarians participated in the study. Seventy-two of 116 clients (62%) and eight of 10 veterinarians (80%) agreed that clients would benefit from veterinary compounds provided in community pharmacies. Only 40% of veterinarians agreed that community pharmacists have the knowledge to compound pet medications, compared to 67% of clients (P=0.010). Similarly, 47% of veterinarians agreed that community pharmacists have the skills to compound pet medications, compared to 72% of clients (P=0.016). Forty-eight of 118 clients (41%) would travel 10 miles or more out of their way for veterinary compounding services at community pharmacies. CONCLUSIONS: This study assessed client and veterinarian perceptions of veterinary compounding service benefits, barriers, and need in community pharmacies. Clients identified more opportunities for veterinary compounding services in community pharmacies when compared to veterinarians. Both groups identified a need for veterinary compounding services and agreed community pharmacies providing these services would benefit pets and clients.

Assessing pet owner and veterinarian perceptions of need for veterinary compounding services in a community pharmacy setting

Background: Pets, pet owners (referred to as clients in veterinary medicine and throughout this article), veterinarians, and community pharmacies may all benefit from veterinary compounding services provided in community pharmacies, but the benefits of this service are not well-documented in the literature. Objectives: This study identified perceived benefits and barriers and evaluated the need for veterinary compounding services in community pharmacies; it also evaluated current business practices related to veterinary compounding services. Methods: A cross-sectional survey was administered to three groups: 1) clients who filled a pet prescription at a study pharmacy, 2) clients who had not filled pet prescriptions, and 3) local veterinarians. Eligible participants were 18 or older; clients must have owned a pet in the past five years. The surveys collected demographic information and assessed benefits, barriers, need, and business practices regarding veterinary compounding services. Demographics were evaluated through descriptive statistics. Responses to Likert-scale items were compared between groups using the Mann-Whitney U test. Qualitative responses were assessed for emerging themes. Results: One hundred eighteen clients and 15 veterinarians participated in the study. Seventy-two of 116 clients (62%) and eight of 10 veterinarians (80%) agreed that clients would benefit from veterinary compounds provided in community pharmacies. Only 40% of veterinarians agreed that community pharmacists have the knowledge to compound pet medications, compared to 67% of clients (P=0.010). Similarly, 47% of veterinarians agreed that community pharmacists have the skills to compound pet medications, compared to 72% of clients (P=0.016). Forty-eight of 118 clients (41%) would travel 10 miles or more out of their way for veterinary compounding services at community pharmacies. Conclusions: This study assessed client and veterinarian perceptions of veterinary compounding service benefits, barriers, and need in community pharmacies. Clients identified more opportunities for veterinary compounding services in community pharmacies when compared to veterinarians. Both groups identified a need for veterinary compounding services and agreed community pharmacies providing these services would benefit pets and clients

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Integrating a health information exchange into a community pharmacy transitions of care service.

OBJECTIVE: To describe the incorporation of a state health information exchange (HIE) into a community pharmacy transitions of care (TOC) service and to assess its impact on 30-day readmission rates. SETTING: Three suburban community pharmacies in Olathe, Kansas. PRACTICE DESCRIPTION: Balls Food Stores is a grocery store chain which operates 21 supermarket community pharmacies in the Kansas City metropolitan area. PRACTICE INNOVATION: Balls Food Stores launched a pharmacist-led self-referral TOC study in which a state HIE was utilized to collect discharge information from patients' electronic medical records (EMRs) to facilitate TOC comprehensive medication reviews (CMRs). EVALUATION: Descriptive statistics were used to assess types and outcomes of identified drug therapy problems and the ability to access Kansas Health Information Network EMRs. A chi-square test was used to assess 30-day readmissions between patients who accepted and declined the service. RESULTS: Forty patients were identified for inclusion and 18 elected to participate in the service. The majority of participants were white females with a median age of 64.5 years. Out of 40 study patients, 85% had an EMR available; 12.5% of patients had a medication list included in their EMR hospitalization documentation. Participants who underwent the service had a statistically significantly lower rate of overall 30-day hospital readmission than those who declined (11.1% vs 36.4%, P = 0.032). Among the 18 TOC CMRs performed, 90 drug therapy problems were identified and 77 were resolved in collaboration with a patient, caregiver, or physician. CONCLUSION: Incorporation of a state HIE into a community pharmacist-led TOC service is a novel strategy for collecting patient data. During the study, no TOC participants were readmitted within 30 days. However, pharmacists found HIE data alone was insufficient to perform TOC CMRs for the majority of participants. In order to expand state HIE utilization, more health systems will need to upload a minimum standard data set to help facilitate care.

Evaluation of Pharmacist-Initiated Interventions on Vaccination Rates in Patients with Asthma or COPD.

To determine if pharmacy-initiated interventions improved the rate of influenza and pneumococcal vaccinations in adult patients with asthma and/or chronic obstructive pulmonary disease (COPD). Adult patients who filled prescriptions at one of three community pharmacies, who had a dispensing history indicative of an asthma and/or COPD diagnosis were randomized to receive a personal phone call or standardized mailed letter recommending influenza and pneumococcal vaccinations, or control with no vaccination information. The rate of influenza and pneumococcal vaccinations was measured for each group and measured using Chi square. Of 831 eligible participants, 210 patients completed the study, and self-reported a diagnosis of asthma and/or COPD. The influenza vaccine was administered to 56 (72.7%), 55 (87.3%), and 62 (88.6%) patients (p = 0.019); pneumococcal vaccine was administered to 46 (59.7%), 39 (61.9%), and 39 (55.7%) patients in the phone call, letter, and control groups, respectively. While the control group had significantly more influenza vaccinations, between the interventions the letter showed a higher rate of influenza vaccination over the phone call. Reviewing patients under age 65, the letter had a significantly higher rate of influenza vaccination than the phone call (p = 0.021). No significant improvement was found for the pneumococcal vaccination. Patients under age 65 who received a mailed letter had a significantly higher rate of influenza vaccination than those who received a phone call, and had a higher rate of pneumococcal vaccination. A standardized, mailed letter may help community pharmacists improve vaccination rates in patients with asthma and/or COPD.

Variability in Potency Among Commercial Preparations of Berberine.

Berberine is an isoquinoline alkaloid plant extract that is widely available as a dietary supplement in the United States and has demonstrated efficacy in the treatment of type 2 diabetes mellitus and dyslipidemia. Because of its increased use and purported pharmacological properties, potential variations in product quality could pose a barrier to berberine's safety and effectiveness in clinical practice. Thus, this study evaluated the potency of dietary supplements containing berberine available in the U.S. commercial market. Fifteen unique dietary supplements containing berberine were purchased through U.S. dietary supplement vendors. For each product, berberine was extracted from 3 unique capsules and analyzed by ultra-high-performance liquid chromatography tandem mass spectrometry. Percentage content based on the product label claim was determined for each product. The average berberine content across the products was found to be 75% ± 25% of the product label claim, with product potency ranging from 33% to 100%. Nine of the 15 tested products (60%) failed to meet the potency standards of 90% to 110% of labeled content claim, as commonly required of pharmaceutical preparations by the U.S. Pharmacopeial Convention. Evaluation of the relationship between product cost and the measured potency failed to demonstrate an association between quality and cost. Variability in product quality may significantly contribute to inconsistencies in the safety and effectiveness of berberine. In addition, the quality of the berberine product cannot be inferred from its cost.

Statin-associated muscle symptoms-Managing the highly intolerant.

Musculoskeletal symptoms are the most commonly reported adverse effects associated with statin therapy. Yet, certain data indicate that these symptoms often present in populations with underlying musculoskeletal complaints and are not likely statin related. Switching statins or using lower doses resolves muscle complaints in most patients. However, there is a growing population of individuals who experience intolerable musculoskeletal symptoms with multiple statins, regardless of the individual agent or prescribed dose. Recent randomized, placebo-controlled trials enrolling highly intolerant subjects provide significant insight regarding statin-associated muscle symptoms (SAMS). Notable findings include the inconsistency with reproducing muscle complaints, as approximately 40% of subjects report SAMS when taking a statin but not while receiving placebo, but a substantial cohort reports intolerable muscle symptoms with placebo but none when on a statin. These data validate SAMS for those likely experiencing true intolerance, but for others, suggest a psychosomatic component or misattribution of the source of pain and highlights the importance of differentiating from the musculoskeletal symptoms caused by concomitant factors. Managing the highly intolerant requires candid patient counseling, shared decision-making, eliminating contributing factors, careful clinical assessment and the use of a myalgia index score, and isolating potential muscle-related adverse events by gradually reintroducing drug therapy with the utilization of intermittent dosing of lipid-altering agents. We provide a review of recent data and therapeutic guidance involving a focused step-by-step approach for managing SAMS among the highly intolerant. Such strategies usually allow for clinically meaningful reductions in low-density lipoprotein cholesterol and an overall lowering of cardiovascular risk.

Comprehensive medication review recipients' opinions, actions, and information recall.

OBJECTIVES: Assess patients' and caregivers' perceptions of comprehensive medication review (CMR) offers and when a CMR is needed, follow-up actions performed after the CMR, and recall of pharmacists' recommendations made during CMRs. METHODS: A 22-item cross-sectional survey with multiple response, 5-point Likert scale (1 = strongly disagree; 5 = strongly agree), yes/no, and free response prompts was administered to patients and caregivers who completed a CMR between October 1, 2014, and September 30, 2015. Surveys were administered to study participants by telephone or by mail if they were not reachable by telephone. RESULTS: Eighty of 141 surveys were completed (57%). Respondents were mostly white, female, and age 65 years or older, with an annual income less than $25,000. Respondents indicated that they were likely to accept CMR offers from pharmacists or pharmacy technicians they know (100% and 94%, respectively) and by telephone call (90%). Respondents strongly agreed that CMRs should be completed annually and when initiating medication for a new diagnosis (median = 5; interquartile range, 3-5). Most respondents received at least 1 recommendation (90%), recalled receiving their CMR summary (66%), and discussed their CMR with their prescribers (67%). Respondents who reported receiving a pharmacist recommendation during their CMR were more likely to strongly agree they should have an annual CMR (P = 0.009). Accurate recall of recommendations made during CMRs was 54%. General health and medication recommendations were significantly associated with respondents' recall of recommendations (P = 0.011 and P = 0.045, respectively). CONCLUSION: Patients and caregivers who received a CMR stated that they are likely to accept future CMR offers from a pharmacist or technician with whom they are familiar, and more patients and caregivers would accept offers by telephone than by other methods. In addition, a newly diagnosed condition presents an opportunity for strategic CMR appointment offers. Although pharmacists regularly made therapy interventions during CMRs, it is important to ensure that CMR recipients have clear instructions for follow-up with their prescribers.

Home-Based Comprehensive Medication Reviews: Pharmacist's Impact on Drug Therapy Problems in Geriatric Patients.

OBJECTIVE: To evaluate the effects of pharmacist-conducted, home-based comprehensive medication reviews (CMRs) on drug therapy problems (DTPs) in geriatric patients. DESIGN: Pre-/postintervention study. SETTING: Grocery store chain affiliated with three independent living facilities. PARTICIPANTS: Twenty-five older adults using pharmacy delivery services for at least three chronic medications. INTERVENTION: A pharmacist conducted a home-based CMR for each participant. DTPs were identified across 13 categories. Patients received a medication action plan post-CMR. A follow-up patient phone call was completed two weeks following the appointment. Patient profiles were reviewed for three months postintervention for changes in DTPs. MAIN OUTCOME MEASURES: Changes in DTPs per patient and changes in five Centers for Medicare & Medicaid Services triple-weighted Star Rating performance measures. RESULTS: The average DTPs identified per patient were reduced from 3.4 ± 2.06 to 1.48 ± 1.68 (P < 0.05) DTPs three months postintervention. The most common categories identified-nonadherence and incorrect administration/ technique-were significantly reduced (P = 0.012 and P = 0.010, respectively). One Star Rating performance measure significantly improved: 68% of patients taking hypertension medications were adherent at baseline and 91% were adherent three months post-CMR (P = 0.016). CONCLUSION: Pharmacist-provided, home-based CMRs reduced the average number of DTPs per patient. The most common categories of DTPs identified-nonadherence and incorrect administration/technique-were reduced postintervention.

Statin-Associated Diabetes Mellitus: Review and Clinical Guide.

A small but significant link between new-onset diabetes mellitus (NOD) and statin therapy was noted with rosuvastatin users in the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin study. Since then multiple analyses have further confirmed this association, with most studies demonstrating a modest increase in NOD with statin therapy, especially among individuals with risk factors for developing diabetes mellitus. More recent observational analyses suggest a stronger correlation between statin use and NOD, however. A definitive mechanism confirming causation between statins and glucose impairment remains elusive, but many have been proposed. Although considered a class effect by the US Food and Drug Administration, most data indicate NOD is dependent upon the dose and potency of the statin, with certain agents appearing to be less diabetogenic. The consensus is that the benefits of statin therapy far outweigh the risk of NOD, especially among patients with high cardiovascular risk. Nonetheless, more studies are needed to better understand this association and long-term clinical implications. In the meantime, we provide clinicians with a practical guide to assist with clinical decision making when prescribing statin therapy. Overall, this article serves to provide the primary care physician with a timely review of the most clinically relevant data regarding statins and NOD, with hopes to ultimately optimize statin prescribing and limit any potential drug-induced glucose impairment.

Patient Satisfaction With Pharmacist-Led Chronic Disease State Management Programs.

PURPOSE: To assess patient satisfaction, perception of self-management, and perception of disease state knowledge with pharmacist-led diabetes and cardiovascular disease state management (DSM) programs. METHODS: A self-insured chain of grocery store pharmacies in the Kansas City metropolitan area administers pharmacist-led diabetes and cardiovascular DSM programs for eligible employees and dependents. A modified version of the Diabetes Disease State Management Questionnaire was used to assess patient satisfaction with the DSM programs. Demographic information was also collected. Survey items were based on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). Patients were eligible to complete the survey if he or she had been in at least 1 DSM program for 6 months. Data were assessed using descriptive statistics and analysis of variance. RESULTS: Across 20 pharmacies, 281 eligible participants were identified, and 46% (n = 128) completed a survey. Means for summed items relating to overall satisfaction (8 items), self-management (5 items), and knowledge (4 items) were 36.6/40 (standard deviation [SD] = 3.9), 20.9/25 (SD = 3.4), and 17.6/20 (SD = 2.1), respectively. Participant comments further indicated that the program and pharmacists are helpful and increase motivation and accountability. CONCLUSIONS: Positive patient responses to the program support use of pharmacist-led DSM programs.

Participant satisfaction with a community-based medication synchronization program.

OBJECTIVE: To assess participant satisfaction with a community pharmacy-based medication synchronization program. SETTING: A single location of a grocery store pharmacy chain in the Kansas City metropolitan area. PRACTICE DESCRIPTION: A medication synchronization program, Time My Meds (TMM), was implemented in 1 of 20 community pharmacies within the grocery store chain. PRACTICE INNOVATION: Current pharmacy patients taking three or more chronic medications were recruited to enroll in the medication synchronization program. After at least 3 months of enrollment in TMM, participants were invited to complete a paper survey to assess satisfaction with the program. EVALUATION: Data were collected on overall participant satisfaction with the TMM program. A 10-statement survey gathered demographic information and assessed participant satisfaction using a 5-point Likert scale (1, strongly disagree, to 5, strongly agree). RESULTS: Data collected from 48 surveys were analyzed. No statistical differences in participant satisfaction were found when considering age, education, income, number of medications at pick-up, or number of monthly trips to the pharmacy prior to program enrollment. Median scores for individual survey items were all 5 out of 5 (strongly agree) using a 5-point Likert scale. CONCLUSION: Participants were highly satisfied with the medication synchronization program. These results, if expanded to a wider population, might provide valuable information for continued justification and implementation of this type of service in community pharmacies.