INNOVATIONS in pharmacy 2022-09-08T13:55:50-05:00 Jon Schommer, Ph.D. Open Journal Systems Inspiring Inquiry and Improvement in Pharmacy Practice, Education, and Policy. A quarterly publication featuring case studies, clinical experiences, commentaries, idea papers, original research, review articles, and student projects that focus on leading edge, novel ideas for improving, modernizing, and advancing pharmacy practice, education, and policy. INNOVATIONS in pharmacy. Consumer Perceptions of a Shingles Infograph Intervention and Vaccination Plans in Community Pharmacy Settings 2022-06-13T10:34:47-05:00 Radhika Devraj Miranda Wilhelm Maithili Deshpande <p><strong>Background: </strong>Cost and lack of knowledge are key barriers to improving shingles vaccination rates in community pharmacies. A health literacy (HL) tailored infograph intervention addressing these barriers can enhance consumer interest in shingles vaccinations. </p> <p><strong>Objectives: </strong>The objectives were to: 1) design a health literacy tailored shingles infograph addressing cost and knowledge about vaccination barriers, 2) determine consumer perceptions of infograph usefulness, and 3) determine factors associated with shingles vaccination plans.</p> <p><strong>Methods: </strong>An infograph addressing the study objectives, and a 22-item self-administered questionnaire assessing shingles vaccine awareness, HL, infograph usefulness, and vaccination plans were designed. The infograph was pilot tested with pharmacists and two community-based focus groups. Inclusion criteria consisted of age-eligible consumers at one chain and three independent community pharmacies. Consenting participants first reviewed the infograph and then completed the survey. Descriptive statistics and multivariable logistic regression analyses were performed. </p> <p><strong>Results: </strong>Of the 422 eligible consumers approached, 112 participated in the study, with 55.4% from the chain pharmacies. Participants were female (56%), white (94%), between 50-70 years old (77%), had adequate HL (96%) and aware of the shingles vaccine (87%). While only 8% of the respondents considered vaccinating on the survey date, 46% considered it in the future, and 29% planned to in the next six months. The infograph was useful (90%) in recognizing vaccination need, was readable (95.5%), and understandable (96%). Consumers who found the infograph useful were significantly more likely to have vaccination plans (OR= 4.06, CI: 1.37 – 11.9, p=0.016). </p> <p><strong>Conclusion: </strong>A shingles vaccine infograph focused on key barriers to vaccination was well-received and useful in promoting consumers’ vaccination plans. </p> 2022-09-08T00:00:00-05:00 Copyright (c) 2022 Radhika Devraj, Miranda Wilhelm, Maithili Deshpande Hyponatremic Cognitive Dysfunction Resulting from Drug-Drug-Gene Interaction between Sertraline and Cannabidiol in an Intermediate CYP2C19 Metabolizer Patient 2022-06-13T10:14:34-05:00 Jade Nanan Sheena Crosby Michael J. Schuh <p><strong>Background: </strong>Pharmacogenomics (PGx) can provide more precision in determining causation of adverse drug reactions (ADRs) from drug-drug-gene interaction clinical application.</p> <p><strong>Case Summary: </strong>Patient was an intermediate CYP2C19 metabolizer on stable therapy taking a low but therapeutic dose of sertraline for depression and anxiety over a period of 20 years. The patient then became hyponatremic and cognitively impaired after addition of cannabidiol (CBD) to this sertraline regimen. The proposed mechanism was drug-drug-gene interaction of CBD further inhibiting the CYP2C19 metabolism of sertraline and increasing drug exposure to produce moderate to severe hyponatremia and subsequent cognitive dysfunction.</p> <p><strong>Practice Implications: </strong>Pharmacogenomics (PGx) testing may assist in etiology of patient symptoms from adverse drug reactions (ADRs) or drug-drug interactions by combining these with detection and application of drug-gene interactions. This case shows inhibition of CYP2C19 by CBD to further increase sertraline exposure, producing hyponatremia and subsequent cognitive dysfunction through CYP2C19 phenoconversion by CBD.</p> 2022-09-23T00:00:00-05:00 Copyright (c) 2022 Jade Nanan, Sheena Crosby, Michael J. Schuh Comparison of the Seasonal Influenza Vaccination amidst the 2020 COVID-19 Pandemic within Six Regional Community Pharmacies of a Large Pharmacy Chain 2021-11-30T10:50:06-06:00 Haley Pressley Erica Shelton Krista Capehart Betsy Elswick Gretchen Garofoli <p><strong>Background</strong>: The CDC has issued interim guidance on administering influenza vaccines amidst the COVID-19 pandemic including providing specific appointment times. A large chain pharmacy has adopted this guidance and is encouraging patients to make appointments rather than a walk-in visit for the influenza vaccination to help avoid large crowds.</p> <p><strong>Objective(s)</strong>: This study aims to determine the impact of the COVID-19 pandemic on influenza vaccination rates (2019 versus 2020 season) and patient appointments versus walk-in visits. The second goal of this study is to evaluate patient satisfaction with the influenza vaccination process.</p> <p><strong>Methods</strong>: Influenza vaccine data was collected from the chain pharmacy online database from the first week in September to the last week in December during 2019 to 2020 and from 2020 to 2021. The second part of this study included a voluntary survey to be completed by the patient regarding satisfaction and thoughts about the 2020-2021 influenza vaccination process.</p> <p><strong>Results</strong>: The six stores identified showed an overall 7.6% increase in influenza vaccination rates from the 2019-2020 season to the 2020-2021 season (p-value= 0.73). There were a total of 15 survey respondents amongst the stores of which 100% of the patients were at least slightly comfortable with the vaccination process and very satisfied overall.</p> <p><strong>Conclusion</strong>: The six pharmacy locations within a large chain revealed that COVID-19 had a positive impact on influenza vaccination rates. Although these results were not statistically significant, this study sets the framework for future vaccination studies.</p> 2022-09-26T00:00:00-05:00 Copyright (c) 2022 Haley Pressley, Erica Shelton, Krista Capehart, Betsy Elswick, Gretchen Garofoli Roles of Community Pharmacists in Cancer Management 2022-08-10T11:12:32-05:00 Oluwaseyi Muyiwa Egbewande Muhsinah Adesewa Abdulwasiu Rashidat Onyinoyi Yusuf Aishat Bisoye Durojaye Zainab Ikeoluwa Ashimiyu-Abdusalam <p>Community pharmacists are among the most easily accessible healthcare practitioners and are usually the first point of contact with the public or community. This is often due to their accessibility, credibility, and widespread within the public sector making them essential members of the healthcare team with significant contributions to the delivery of public health care. Community pharmacists, in addition to their known educational and awareness-raising roles, may play an essential role in risk assessment and screening of patients, detection of symptoms of probable malignancy, and cancer treatments. The pharmacy profession has been evolving from dispensing roles into more patient-oriented outcomes and pharmacists are now participating in more clinical interventions. This places community pharmacists in the best position to provide the necessary knowledge and healthcare to benefit populations at risk of cancer. Active involvement of community pharmacists in the care and management of cancer will significantly contribute to screening and risk assessment, early detection, treatment and eradication of breast, cervical, lung, ovarian and other forms of cancer. As a result, the community pharmacy setting must the developed to maximize its full potential in cancer care.</p> 2022-09-30T00:00:00-05:00 Copyright (c) 2022 Oluwaseyi Muyiwa Egbewande, Muhsinah Adesewa Abdulwasiu, Rashidat Onyinoyi Yusuf, Aishat Bisoye Durojaye, Zainab Ikeoluwa Ashimiyu-Abdusalam Development of a Propensity to Self-Medicate with Over-the-Counter Medicines Scale (PSM-OTC) 2022-07-01T11:17:34-05:00 Oluwasola Ayosanmi Marjorie Delbaere Jeff Taylor <p><strong>Objective</strong>: To develop a valid and reliable scale to measure the public’s propensity to self-medicate with OTC medicines.</p> <p><strong>Method:</strong> Propensity construct items were obtained from the literature and also created as new entities. Three experts reviewed the item pool for face validity. Internal consistency was assessed using Cronbach’s alpha. Test-retest reliability was estimated using Pearson correlation coefficients (r), Intraclass Correlation Coefficients (ICC) and paired sample t-tests. Further test-retest reliability assessed the degree of change in responses in a subset of subjects from time 1 to time 2 (one month apart) for each item on the scale.</p> <p><strong>Results</strong>: From the pool, 16 items were assessed for applicability to the propensity construct. Factor Analysis identified four components and were labelled as purchase involvement, self-efficacy, awareness of care needed during self-medication, and the therapeutic usefulness of OTC medicines. The internal consistency of the 16-item scale was sufficient; overall alpha was 0.9 and each construct had an alpha of 0.7 to 0.8. Test-retest reliability coefficients (r) for the four components were reassuring, ranging from 0.4 to 0.5, while the ICC values ranged from 0.5 to 0.7. A paired sample t-test showed no statistically significant difference in the rating at the two iterations for each of the constructs, thereby suggesting good reliability of the data. Over 50% of respondents did not change their original response to the 7-point scales (strongly disagree (1) to strongly agree (7)) for 9 out of 16 items. Factor loading from Principal Component Analysis led to the reduction of the 16-items scale to a 15-item Propensity to Self-Medicate with OTC Medicines Scale.</p> <p><strong>Conclusion:</strong> The developed tool for measuring the propensity to self-medicate with OTC medicines showed acceptable performance of internal consistency and reliability. The scale may have research potential in assessing the self-medication propensity of different cohorts of society.</p> 2022-10-03T00:00:00-05:00 Copyright (c) 2022 Oluwasola Ayosanmi, Marjorie Delbaere, Jeff Taylor The Potential Effects of Implementing an Antibiotic Stewardship Program by Integrating It with Medication Therapy Service in a Low-Income Serving Clinic - A Single-Center Experience 2022-08-10T11:26:13-05:00 Arinze Nkemdirim Okere Miquetta L. Trimble Vassiki Sanogo Ukamaka Smith Clyde Brown Sarah G. Buxbaum <p><strong>Background: </strong>Bacterial antimicrobial resistance (AMR) is a leading cause of mortality worldwide. Although AMR is common in low-income communities, there is limited evidence of the effect of antibiotic stewardship programs in low-income communities in the United States.</p> <p><strong>Objectives:</strong> Our goal is to assess the effects of implementing pharmacist-led ASP by integrating it with medication therapy management service (MTM) in a low-income serving clinic. We evaluated the following 1) antibiotic prescriptions per 1000 patients, 2) the frequency of clinic (office) visits 30-day post-index clinic visits for recurring infections.</p> <p><strong>Methods:</strong> <strong> </strong>To achieve our goal, we conducted a pre-post, quasi-experimental intervention study using an interrupted time-series analysis to assess the following: 1) antibiotic prescriptions per 1000 patients and the 2) frequency of office visits (including telehealth) within 30-day post-index clinic visits associated with recurrent infection.</p> <p><strong>Results: </strong>Our findings revealed that the long-term effect of our antibiotic stewardship program intervention was associated with 63.69% reduction in antibiotic prescriptions per 1000 patients (change in slope = -0.173, [95% CI: (-0.30, -0.05)], P &lt; 0.007) and a reduction in the frequency of office visits within 30-day post-index clinic visits by 67.27% (change in slope = -2.043, [95% CI: (-3.84, -0.24)], P &lt; 0.028).</p> <p><strong>Conclusion: </strong>Implementing antibiotic stewardship programs is feasible for clinics serving low-income populations. It was associated with a reduction in antibiotic prescriptions and preventable clinic (office) visits within 30 days due to infection recurrence.</p> 2022-10-03T00:00:00-05:00 Copyright (c) 2022 Arinze Nkemdirim Okere, Miquetta L. Trimble, Vassiki Sanogo, Ukamaka Smith, Clyde Brown, Sarah G. Buxbaum Association of Coping Strategies and Medication Adherence: A Systematic Review 2022-08-10T11:09:00-05:00 Avinash Chatoo SuHak Lee <p><strong>Background: </strong>Medication adherence is difficult for most patients who take at least one medication. Poor drug adherence is a developing problem since it contributes to negative outcomes, prescription waste, increased healthcare expenses, and disease progression. Coping strategies are an important tool for managing a patient's condition because a patient's coping method influences how he or she perceives the situation and deals with the stress that comes with it, which can eventually affect adherence. Coping strategies are classified into five categories: problem-focused, emotion-focused, seeking understanding, support seeking, and problem avoidance<strong>.</strong></p> <p><strong>Objective: </strong>The goal of this study is to examine and illustrate the association of coping strategies on medication adherence.</p> <p><strong>Method: </strong>A systematic review of PubMed/MEDLINE database was conducted in order to screen and select articles. A total of 15 studies were included where they were classified by endpoints. Endpoints that were considered are medication adherence, problem-solving/active coping strategy, emotion-focused coping strategy, seeking understanding coping strategy, support seeking coping strategy and problem avoidance coping strategy. The association of each coping strategy on medication adherence was then evaluated from each article assigned to every category of coping strategies to determine if it had a favorable, negative, or no impact on medication adherence.</p> <p><strong>Results: </strong>Most studies which measured problem-solving/active coping strategy (78%) had a positive association on medication adherence, followed by studies which measured emotion-focused coping strategy (69%). Majority of the studies that evaluated for problem avoidance coping strategy (50%) showed a negative association on medication adherence and a small proportion of studies (30%) showed a positive association. Four(4) of the 5 coping strategies (problem-solving/active, emotion-focused, seeking understanding and support seeking) were found to have a greater number of studies showing positive association to medication adherence as opposed to problem avoidance.</p> <p><strong>Conclusion: </strong>The findings may suggest that problem-solving and emotion-focused coping strategies can be useful to help people with chronic conditions improve their medication adherence. More study is needed to establish a link between coping strategies and medication adherence in patients, which will allow pharmacists and other healthcare professionals to deliver better interventions to patients and assess for medication nonadherence due to poor coping skills.</p> 2022-10-05T00:00:00-05:00 Copyright (c) 2022 Avinash Chatoo, SuHak Lee Formulary Submissions: Value Claims, Protocols and Outcomes Based Contracting in Rare Disease 2022-08-29T12:20:43-05:00 Paul Langley <p>Outcomes based payments contracting is in its infancy<strong>. </strong>The increased attention being given to rare disease place a premium on the ability to engage with payers to ensure that there is an analytical framework relevant to value claims contracting. Rare disease is not, of course, alone; many other chronic disease states may be suitable candidates and have been over the past 10 years or more. Rare disease, however stands apart: (i) the evidence base at product launch is limited; (ii) the therapy costs are often considered prohibitive; and (iii) the target patient population is small. At the same time, those seeking to implement an evidence-based engagement with health systems to support innovative rare disease interventions face a substantive technology assessment barrier. The focus in health technology assessment on assumption driven modeled cost-effectiveness simulations that support imaginary recommendations for cost-effective pricing and access is, however, an avoidable barrier. In the US, this barrier is the business model of the Institute for Clinical and Economic Review (ICER) and one endorsed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Rare disease can be better served with other tools at our disposal with a proposed new start analytical framework in health technology assessment. The purpose of this brief note is to make the case that this proposed new start focused on single attribute value claims that meet the standards of normal science and fundamental evidence can not only dispense with the ICER imaginary modeling but, with a new start formulary submission package, integrate value claims with assessment protocols to set the stage for effective outcome-based contracting as the default standard for future payer negotiations.</p> 2022-10-03T00:00:00-05:00 Copyright (c) 2022 Paul Langley Exploring the Impact of Reflecting upon Pharmacy Experts’ Written Career Guidance on Student Professional Identity Formation 2022-04-12T18:56:01-05:00 Laurie L. Briceland Tatiana Martinez <p><strong>Study Objective: </strong>To explore the impact of reading and critically reflecting upon professional development guidance provided by pharmacy experts upon student professional identity formation (PIF).</p> <p><strong>Methods</strong>: Fifteen second professional year student pharmacists completed an elective course assignment to read 20 published personal letters from Letters to a Young Pharmacist, in which pharmacy experts offer career and life guidance to novice or student pharmacists. From those, each student selected four letters and for each composed a 500 to 600-word critical reflection describing the impact of the letter, yielding 60 reflections for thematic analysis. Each author individually analyzed and coded de-identified reflections for up to 3 types of impact. Data were then grouped for similarity and collapsed into themes; overarching evidence of transformative thinking and “eye-opening” were also coded. </p> <p><strong>Results:</strong> Of 60 reflections, 160 types of impact were identified, and were grouped into five themes. Most often, students described an impact from Personal Growth (41.3%), followed by Professional Growth (16.9%), Forging Relationships (16.2%), Making an Impact (15%) and Morality (10.6%). “Eye-opening” and “transformative thinking” was evidenced in 21 of 60 (35%) and 53 of 60 (88.3%) reflections, respectively. </p> <p><strong>Conclusions</strong>: Student pharmacists experienced growth in PIF by reflecting upon published excerpts from pharmacy experts, as demonstrated by coding for impact and transformative thinking. This novel method of students’ critically reflecting upon expert’s readings, followed by instructor feedback to reinforce the learning, offers a streamlined and easily implemented modality to enable students PIF development during their didactic curriculum. </p> 2022-09-26T00:00:00-05:00 Copyright (c) 2022 Laurie L. Briceland, Tatiana Martinez Does Team Based Learning (TBL) in the Pharmacy Classroom Foster Leadership Skills in the Workplace? 2022-04-11T14:39:26-05:00 Robert C. Haight Marta J. Brooks <p><strong>Objective</strong>: A well-functioning healthcare team is important to optimizing the health outcomes of patients. As such, the use of Team Based Learning (TBL) in the education of health professionals has emerged as one of the more common active learning strategies. In various anecdotes with preceptors, it had been observed that student pharmacists educated in a TBL classroom exhibited increased skills in the affective domain. This qualitative pilot study begins to examine affective domain skills that are important to pharmacy practice and which of those skills may be developed uniquely through TBL.</p> <p><strong>Methods</strong>: Random samples of preceptors and students (first through fourth-year cohorts), were engaged using a predesigned interview protocol to guide the discussion. Ad hoc questions resulting from the interview were also captured. A grounded theory approach was utilized to develop an a priori theme codebook that was utilized to analyze the interviews with preceptors and focus groups with students.</p> <p><strong>Results</strong>: Nine preceptors were interviewed, and 23 student pharmacists participated in focus groups. Preceptors identified 1) communication, 2) emotional intelligence, 3) education, 4) time management, and 5) advocacy as the top themes important to being a leader. While students identified 1) communicate with or listen to others, 2) accountability/responsibility, 3) patience, 4) self-reflection / feedback as skills developed by TBL. Participants indicated that they believed that TBL was a contributor to the development of affective domain skills among student pharmacists.</p> <p><strong>Conclusion</strong>: Among preceptors and student pharmacists, this initial study found both alignment and divergence with identified skills in the affective domain related to the development of leadership skills. Additional research is needed to further explore and develop an instrument to measure the role of TBL in affective skill development, in the context of being a leader in the pharmacy profession.</p> 2022-09-26T00:00:00-05:00 Copyright (c) 2022 Robert C. Haight, Marta J. Brooks