INNOVATIONS in pharmacy 2022-11-09T13:43:58-06:00 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. TikTok: An Opportunity for Antibiotic Education? 2022-10-17T16:41:48-05:00 Emma Evans Lauren Biehle Gory Aislinn O'Kane <p>Health information and misinformation on social media have become a growing concern for the medical community. Antimicrobial resistance continues to advance, threatening public health and safety. TikTok, a popular social media platform, provides an avenue for providers to educate patients on clinical topics and medication use. As leaders in patient education and counseling, pharmacists are equipped to provide trustworthy information on TikTok and other platforms. Pharmacists can thus advance the practice of pharmacy and build rapport with patients through a new medium. Current health-related videos on TikTok have not been robustly evaluated for quality and reliability. This study evaluates antibiotic-related content from healthcare providers and non-healthcare providers on TikTok for balance, reliability, and quality using the DISCERN score.</p> <p><strong> </strong><strong>Introduction</strong>: Antimicrobial resistance is increasing at an alarming rate. Patient education is a critical component of both stewardship and combating health misinformation. TikTok is a video-sharing social media platform with 1 billion monthly users and contains videos that discuss health information. The objective of this study was to evaluate antibiotic-themed TikTok videos for their validity and reliability.</p> <p><strong>Methods</strong>: In March 2021, a search on TikTok using the term “antibiotics” was performed and the top 300 consecutive videos were identified. The following data was collected for each video: number of likes, associated disease state, medications, educational aim, mention of COVID-19, and if performed by a healthcare professional (HCP). Non-English language videos were excluded. The DISCERN score was used to evaluate all videos for reliability. Chi-square and Mann-Whitney U were used for statistical analysis. A p-value less than .05 was considered statistically significant.</p> <p><strong>Results</strong>: The first 300 consecutive videos were assessed using the DISCERN score for validity. Of the 300 videos, the majority (n=224) were created by non-health care professionals (non-HCPs). The number of “likes” per video ranged from 1 like to 2 million likes with a mean of 34,949 ± 143,482. Videos produced by HCPs were significantly more valid and reliable (mean DISCERN score of 1.65 vs 1.17, p &lt;0.00001) than non-HCPs. They were found to be more relevant (p&lt;0.00001), have clearer aims (p&lt;0.00001), and were more balanced/unbiased (p=0.00188). Videos created by HCPs were more likely to have an educational focus (p&lt;0.0001). There was no difference between groups in clarity of sources utilized or risk/benefits discussed of each treatment. Across all videos, the most common disease states mentioned were urinary tract infection, skin and soft tissue infection, upper respiratory tract infection, and dental infection. Herbal or supplement products, penicillins, and sulfa antibiotics were the most commonly discussed medications.</p> <p><strong>Conclusions</strong>: Videos created by HCPs were significantly more valid and reliable than those created by non-HCPs. The videos created by HCPs were also more likely to have clear aims and be more relevant. However, the majority of the videos evaluated were created by non-HCPs. It may be beneficial for HCPs to provide informative TikTok videos that are valid and reliable for patient education.</p> 2022-11-17T00:00:00-06:00 Copyright (c) 2022 Emma Evans, Lauren Biehle Gory, Aislinn O'Kane Virtual Social Networking Hours: A Vital Personal and Professional Avenue for Connecting Pharmacy Leadership Educators 2022-05-06T14:51:31-05:00 Gregory Zumach Whitney D. Maxwell Kerry K. Fierke <p>The American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) created a Virtual Social Networking Hour (VSNH). The VSNH explored pharmacy leadership educators' connections through discussing topics of interest that influence current teaching and scholarship practices. The VSNH also served to connect members in the LD SIG through informal networking, which was vital during a time when in-person connection was heavily restricted due to the COVID-19 global pandemic.</p> <p>The VSNH functioned as both a space for members to connect with LD SIG leadership and other members of the LD SIG and a tool to areas of leadership development the SIG should explore in future programming. Each of the four sessions included a skeleton structure that grew organically based on the conversations of the attendees. Common themes of scholarship, adaptation to a virtual landscape, leadership, and student-focused endeavors were interwoven across all four sessions. The VSNHs have since become an integral component in LD SIG Programming.</p> 2023-01-10T00:00:00-06:00 Copyright (c) 2023 Gregory Zumach, Whitney Maxwell, Kerry Fierke Rasch Measurement and Patient Reported Value Claims: A Primer for Hemophilia 2022-10-17T09:26:55-05:00 Paul C Langley <p>This commentary proposes that Rasch Measurement Theory (RMT) is an innovative method for assessments of patient-centric therapy response in hemophilia A and B, as they are in other disease states or target patient populations. RMT is a necessary and sufficient approach to moving from ordinal observations to interval measurement, which has arithmetic properties. This applies across the board in hemophilia and other disease states for clinical value claims, patient centric or subjective value claims as well as those for anticipated drug utilization and other medical care resources. The purpose of this commentary is to point out limitations regarding current methods for making claims regarding hemophilia response and to propose a new start in hemophilia studies to identify core claims that meet required measurement standards. This applies to both the development of new patient reported outcome instruments as well as the evaluation of existing instruments, with a focus on polytomous instruments and their sub-domains, to evaluate their possible application as measures that approximate RMT requirements.</p> 2022-12-16T00:00:00-06:00 Copyright (c) 2022 Paul C Langley Impact of an Emergency Department Simulation on Pharmacy Students’ Interprofessional Team Skills and Attitudes 2022-04-23T18:26:03-05:00 Michael P. Kelsch Rebecca Brynjulson Allison Hursman Amy Werremeyer Heidi N. Eukel <p><strong>Objective: </strong>To evaluate the impact of an emergency department simulation on pharmacy students’ interprofessional team skills and attitudes as measured by a novel mixed methods approach.</p> <p><strong>Methods: </strong>A simulated emergency department encounter was executed by interprofessional teams consisting of pharmacy and medical students. Two rounds of the same encounter were separated by a short debriefing session facilitated by pharmacy and medical faculty. A full, comprehensive debriefing session occurred after conclusion of the second round. Pharmacy faculty evaluated pharmacy students using a competency-based checklist after each round of the simulation. Pharmacy students completed a baseline self-assessment of their interprofessional skills and attitudes pre-simulation, and again post-simulation. </p> <p><strong>Results:</strong> Pharmacy students demonstrated significant improvement in providing clear and concise verbal interprofessional communication and using shared decision making to develop a collaborative plan of care, based upon student self-assessment and faculty observational ratings. Student self-assessments also showed significant perceived growth in contributing to the team’s plan of care, and demonstrating active listening skills within the interprofessional team. Through qualitative analysis, pharmacy students noted perceived self-improvement in a variety of team-based skills and attitudes including confidence, critical thinking, role identification, communication, and self-awareness. </p> <p><strong>Conclusion: </strong>This simulation provided a learning opportunity for pharmacy students to improve their skills related to teamwork and interprofessional collaboration. Based upon a novel a mixed methods assessment, both student self-assessment and faculty observational ratings were associated with significant growth in interprofessional skills and attitudes. This simulation provides a template experience for colleges/schools to meet, at least in part, ACPE Standards related to interprofessional education in collaboration with medical students. </p> 2022-11-09T00:00:00-06:00 Copyright (c) 2022 Michael P. Kelsch, Rebecca Brynjulson, Allison Hursman, Amy Werremeyer, Heidi N. Eukel Establishing an Experiential Liaison Position to Increase IPPE and APPE Capacity and Preceptor Satisfaction in the Health System Environment 2022-04-23T17:06:16-05:00 Toral Patel Wesley Nuffer Eric Gilliam Megan Thompson <p><strong>Description of the problem: </strong>Providing experiential experiences for student pharmacists within health systems can be challenging for schools of pharmacy. Establishing clinical faculty practices within health systems enables schools to increase student placements, however the clinical faculty typically prioritize experiential education within their individual clinical practice and may not be positioned to develop experiential education opportunities across the site.</p> <p><strong>Description of the innovation: </strong>A novel clinical faculty position, the experiential liaison (EL), established at the school’s largest health system partner to focus on improving the quality and quantity of experiential education across an academic medical center (AMC).</p> <p><strong>Critical analysis: </strong>University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science (SSPPS) identified interested preceptors, recognized and coordinated preceptor development, and facilitated development of quality experiential activities within the site through the establishment of the EL position. Since the establishment of the EL position, student placement at the site increased to 34% of SSPPS’s experiential placements in 2020. A high number of preceptors answered “strongly agree or agree” to understanding SSPPS’s curriculum, expectations from the school, how to utilize assessment tools to measure student performance on rotation, and how to provide feedback to the school. Preceptor development opportunities are routine and effective, and the relationship between the school and hospital is collaborative.</p> <p><strong>Implications: </strong>Establishing an experiential liaison clinical faculty position within a health system is a feasible strategy for schools to further increase experiential education placements in health systems.</p> 2022-11-21T00:00:00-06:00 Copyright (c) 2022 Toral Patel, Wesley Nuffer, Eric Gilliam, Megan Thompson Beginning Early: Reflective Practice Development in a Pre-health Course on Health Literacy and Health Disparities 2022-05-28T16:28:13-05:00 Jody L. Lounsbery Anna Milone Claire Fenimore Amy L. Pittenger <p><strong>Background</strong>: Learning reflective practices and understanding the complexity of health literacy and health disparities need to start early in health professions training. The primary objective of this inquiry was to evaluate the feasibility and effectiveness of using reflection categorization for assessing learner progression on reflective practice development. The secondary objective was to evaluate student reflection as a strategy for introducing and advancing pre-professional learners' understanding of health literacy and health disparities.</p> <p><strong>Case Description</strong>: Within an online undergraduate health literacy course, two written reflection assignments were coded using Kember’s four categories: habitual action, understanding, reflection, and critical reflection. Students received feedback based on this reflection categorization to promote development of reflective practices. However, reflections were not graded using the reflection categorization.</p> <p><strong>Case Themes</strong>: Most (78%) students were at the level of understanding for the first reflection. For the second reflection, 29% of students were at the reflection level, demonstrating health literacy application and describing the important contributing role of personal context to health outcomes. Sixteen (33%) students progressed in their level of reflection. Within the reflections, students discussed knowledge gained and plans for future application.</p> <p><strong>Conclusion</strong>: Using a structured reflection activity allowed pre-health students to begin developing reflection practices. Through reflection, students were able to describe and apply health literacy and health disparities knowledge.</p> 2022-11-23T00:00:00-06:00 Copyright (c) 2022 Jody L. Lounsbery, Anna Milone, Claire Fenimore, Amy L. Pittenger What’s Trending on Twitter Regarding the Most Recently Approved Oral Agent for HIV Pre-Exposure Prophylaxis (PrEP)? 2022-10-17T17:12:11-05:00 Alexandria Boot Crystal Deas <p><strong>Introduction:</strong> Pre-exposure prophylaxis (PrEP) is a key therapeutic strategy for HIV prevention. Descovy<sup>®</sup> is the most recently approved oral agent for PrEP. Despite availability, there continues to be suboptimal PrEP use among at-risk individuals. Social media platforms have a role in disseminating health information, to include education on PrEP.</p> <p><strong>Material and methods:</strong> A content analysis was conducted of “tweets” posted on Twitter<sup>®</sup> during the initial year of Descovy’s FDA approval for PrEP. The coding schema captured content related to the indication, appropriate use, costs, and safety profile of Descovy.</p> <p><strong>Results:</strong> Most tweets provided information on target population, dosing strategy, and side effects of Descovy. Information on costs and appropriate use was frequently missing.</p> <p><strong>Conclusion:</strong> Health educators and providers should be aware of gaps in social media messaging concerning PrEP and should educate patients to ensure they are well informed when considering PrEP.</p> 2022-11-16T00:00:00-06:00 Copyright (c) 2022 Alexandria Boot, Crystal Deas Student Service-Learning Projects: Good Intentions, Questionable Impact 2022-09-09T17:04:35-05:00 Saara Z. Nasruddin Meagen Rosenthal Vibhuti Arya <p>Student pharmacist-led service-learning projects aimed at community engagement generally provide health education while promoting the pharmacy profession. Many such projects often assume the needs and wants of community residents, and key community partners are often left off the decision-making table when it comes to planning. This paper will offer some reflection and guidance for student organizations to consider when planning projects, with a focus on local community partnerships to identify and address needs for more meaningful and sustainable impact.</p> 2022-11-23T00:00:00-06:00 Copyright (c) 2022 Saara Z. Nasruddin, Meagen Rosenthal, Vibhuti Arya The Urgent Need to Intensify Vaccine Development and Manufacturing in Africa: Lessons from Emerging Pandemics 2022-09-14T10:44:30-05:00 Melody Okereke Habeebullah Oladipo Mercy Aransiola Faridah Adebowale Habib Yusuf <p>Over the years, the African continent has been severely plagued by disease outbreaks, most of which have resulted in devastating pandemics. Despite having the greatest burden and impact of these disease outbreaks, regional efforts to develop and manufacture vaccines in the continent have been inadequate, with a potential impact on pandemic preparedness and readiness efforts in the continent. Given that disease outbreaks are still likely to occur in the future, we discuss the urgent need to intensify vaccine development and manufacturing in Africa based on the lessons learnt from emerging pandemics.</p> 2022-11-09T00:00:00-06:00 Copyright (c) 2022 Melody Okereke, Habeebullah Oladipo, Mercy Aransiola, Faridah Adebowale, Habib Yusuf Community Pharmacist Provision of Non-Dispensing Services in Health Professional Shortage Areas 2022-06-13T11:49:17-05:00 Haley Kessinger Emily Landis Natalie DiPietro Mager Karen Kier <p>Individuals living in primary care health professional shortage areas (HPSAs) experience health inequities. Community pharmacists are healthcare professionals with an opportunity to provide care to underserved populations. The objective of this study was to compare non-dispensing services provided by Ohio community pharmacists in HPSAs and non-HPSAs. Methods: An electronic, IRB-approved 19-item survey was sent to all Ohio community pharmacists practicing in full-county HPSAs and a random sample practicing in other counties (n=324). Questions assessed current provision of non-dispensing services as well as interest and barriers regarding such services. Results: Seventy-four usable responses were received (23% response rate). Respondents in non-HPSAs were more likely to recognize their county’s HPSA status than those in an HPSA (p=0.008). Pharmacies in non-HPSAs were significantly more likely to offer 11 or more non-dispensing services than those in HPSAs (p=0.002). Nearly 60% of respondents in non-HPSAs reported starting a new non-dispensing service during the COVID-19 pandemic compared to 27% of respondents in full HPSA counties (p=0.009). Most commonly reported barriers to providing non-dispensing services in both county types included lack of reimbursement (83%), workflow (82%), and space (70%). Respondents expressed interest in learning more information about public health and collaborative practice agreements. Conclusion: While the need for non-dispensing services is great in HPSAs, community pharmacies in full-county HPSAs in Ohio were less likely to provide these services or begin novel services. Barriers must be addressed so that community pharmacists can provide more non-dispensing services in HPSAs to increase access to care and promote health equity.</p> 2022-11-17T00:00:00-06:00 Copyright (c) 2022 Haley Kessinger, Emily Landis, Natalie DiPietro Mager, Karen Kier Pharmacist Impact on Immunization Rates in Asplenic Patients 2022-07-18T16:09:30-05:00 Deidra Van Gilder Shanna K O'Connor <p><strong>Background: </strong>Asplenic patients can present unique challenges when updating immunizations. Pharmacists have proven to have a positive impact on immunization rates in asplenic patients.</p> <p><strong>Objectives: </strong>To determine the impact of pharmacist intervention on the up-to-date immunization status in asplenic patients in a single rural family medicine clinic and identify quality improvement opportunities for the immunization service.</p> <p><strong>Service Description: </strong>The pharmacist obtained an initial list of asplenic patients to create a longitudinal tracking spreadsheet for immunizations that identified missing vaccines for each patient; provider education on vaccine needs in this population and the service was also provided. The ongoing service consists of regular updates to the spreadsheet as patients receive vaccines and a quarterly check of the entire spreadsheet to determine needed vaccines; if needed vaccines are identified, the pharmacist facilitates a patient appointment to obtain the vaccine.</p> <p><strong>Methods: </strong>A retrospective chart review was completed in Spring 2022 for all patients included in the baseline report. Patients were categorized based on vaccine status and outstanding vaccines were noted. An evaluation was completed to determine if any identifiable trends across providers were evident based on patient immunization status.</p> <p><strong>Results: </strong>A total of 33 asplenic patients were identified at baseline; three (9%) were up-to-date at baseline. Of the 30 patients who were maintained in the clinic, 16 (53.5%) were up-to-date at the point of review. Pharmacist intervention increased the total vaccine completion rate by 44.5% from baseline to follow-up. The biggest improvement for a specific immunization status was made on the meningitis b vaccine; Haemophilus influenzae b showed the highest completion rate at follow-up. No trends were noted across providers that indicated why some providers had patients with higher immunization rates than others.</p> <p><strong>Conclusion: </strong>Pharmacist intervention contributed to an increase in immunization rates in a single immunocompromised patient population that requires a specialized immunization schedule.</p> 2022-11-17T00:00:00-06:00 Copyright (c) 2022 Deidra Van Gilder, Shanna K O'Connor Burnout and Resilience in the Community-Based Pharmacist Practitioner 2022-05-24T13:03:41-05:00 Kristine M. Cline Bella Mehta <p><strong>Objective: </strong>The primary objective was to assess presence of community-based pharmacist practitioner burnout and workplace stress through administration of validated tools.</p> <p><strong>Methods: </strong>Pharmacists licensed in Ohio received an invitation to participate in the anonymous online assessment via Qualtrics™ using emails available via the State Board of Pharmacy listserv. The survey assessed emotional exhaustion, depersonalization, and personal accomplishment using a validated tool, the Maslach Burnout Inventory (MBI). The Areas of Worklife Survey (AWS) was used to assess stressors as they relate to burnout and job stress. This study was approved by The Ohio State University Institutional Review Board.</p> <p><strong>Results: </strong>There were 1,425 complete responses. Based on the study sample, 67.2% of community-based pharmacists are experiencing burnout. When asked to self-identify workplace stressors, respondents primarily described the Workload, Control, and Reward dimensions of the AWS. The most commonly reported coping mechanisms were self-care strategies (28.4%), mindfulness (17.6%), and personal time/time off (15.3%). Respondents suggested that organizations address staffing (50.2%) and development of a culture of well-being (17.2%) to promote well-being.</p> <p><strong>Conclusion: </strong>This study allowed insight into workplace stressors for community-based pharmacists and strategies organizations can employ to improve their well-being. Future studies are needed to assess the efficacy of these interventions.</p> 2022-11-23T00:00:00-06:00 Copyright (c) 2022 Kristine M. Cline, Bella Mehta Applying Psychological and Educational Health Models to Determine the Effect of Cognitive and Behavioral Interventions on Tuberculosis Treatment Outcomes in Plateau State, Nigeria 2022-08-29T12:24:14-05:00 Comfort Nanbam Sariem Maxwell Patrick Dapar Nenman Musa Lenka Jacob Kolawole John Aguiyi <p><strong>Background:</strong> The prolonged multi-drug treatment regimen for tuberculosis (TB) can lead to non-adherence and unsuccessful treatment outcomes. Educational and psychological health models can be used to design cognitive and behavioral interventions to improve adherence and treatment outcomes.</p> <p><strong>Objective:</strong> To determine the effect of cognitive and behavioral interventions on TB treatment outcomes.</p> <p><strong>Methods: </strong>The quasi-experimental study conducted in six TB treatment centers involved reinforced medication education and adherence counseling (MEAC), designed from a structured validated psychometric scale. Data were collected three different times during the intensive and continuation phases of treatment from 463 TB patients (232 in the control and 231 in the intervention group). Baseline demographic and clinical characteristics were compared between the groups. The generalized estimating equation model was used to analyze the repeated measures by determining if treatment success was associated with the cognitive and behavioral interventions and medication adherence.</p> <p><strong>Results: </strong>The males made up 290(62.6 %) of the population. The mean age was 36.75±13.9. Most of the TB patients were newly diagnosed 413(89.2%) and HIV negative 315(68%), with secondary level of education 216(46.6%). There was no significant difference in baseline characteristics between the groups. The intervention group was four times more likely to have treatment success (p&lt;0.01; CI=1.5-8.4), compared to the control group. Medication-adherent TB patients were 24 times more likely to have treatment success than patients who did not adhere (p&lt;0.001; 10.8-52.1). TB patients’ emotions, attitudes, and perceptions of their medicines were predictors of treatment success (p&lt;0.05; 1.0 – 1.1).</p> <p><strong>Conclusion: </strong>The cognitive and behavioral interventions administered to TB patients improved successful treatment outcomes.</p> 2022-11-23T00:00:00-06:00 Copyright (c) 2022 Comfort Nanbam Sariem, Maxwell Patrick Dapar, Nenman Musa Lenka , Jacob Kolawole, John Aguiyi Perceptions of Healthcare Providers about Pharmacists’ Clinical Roles in Patient Care in Ghana 2022-08-23T11:29:52-05:00 Akua A. Appiah-Num Safo Olihe N. Okoro Joseph Attakorah <p><strong>Background: </strong>Clinical pharmacy practice is distinguishable from the dispensing model by its focus on direct patient care. To function effectively in this role, pharmacists need to have clinical competencies, hence the establishment of the Doctor of Pharmacy (PharmD) program. In Ghana, the PharmD program is in its early stages; graduating its first set of pharmacists in 2018. There is therefore need to understand how these recent PharmD graduates are engaging in clinical roles and the perceptions of other health professionals they need to work collaboratively with.</p> <p><strong>Methods:</strong> Four different focus group discussions (FGDs) were conducted with physicians, nurses and pharmacists in separate sessions. Questions explored perceptions of the clinical roles of pharmacists. The FGDs were audio-recorded and transcribed verbatim. A thematic analysis of the transcripts was conducted.</p> <p><strong>Results</strong>: Perceptions around the roles of clinical pharmacists were in two categories – (1.) Roles associated with the provision of direct patient care [(i.) assurance of appropriateness, and (ii.) optimization of pharmacotherapy; and (2.) Roles involving participation in inter-professional collaborative care with other healthcare professionals through their (i.) contribution of pharmacotherapy expertise, and (ii.) input in interprofessional education and practice.</p> <p><strong>Conclusion: </strong>Findings from the study highlight perceived contributions of pharmacists, and potential for more relevance to clinical care, while also drawing attention to the emergence of clinical roles of pharmacists in healthcare systems in a global context. There is continuing need for advocacy for the pharmacy profession and policy changes in healthcare delivery models to maximize potential benefits of clinical pharmacists to health outcomes.</p> 2022-11-28T00:00:00-06:00 Copyright (c) 2022 Akua A. Appiah-Num Safo, Olihe N. Okoro, Joseph Attakorah Evaluating the Efficacy of 3 Recruitment Methods for Enrolling Patients in Chronic Care Management Services: A Pilot Study 2022-09-27T14:12:15-05:00 Anastasia B. Jenkins Elizabeth Holley Cory Rogers Natalie Montgomery Adam N. Pate <p>Chronic Care Management (CCM) is a billable service that pharmacists can provide either in person or via telephone in ambulatory clinics or community pharmacies. Pharmacists may use this service to expand current roles in patient care and add billable services to an ambulatory care practice. The number of clinics employing CCM is steadily increasing, and to date, there has been limited information published to aid pharmacists who are considering implementing these services. The purpose of this study is to compare enrollment success in a clinic-based, pharmacist-led CCM service using three recruitment strategies to enroll patients: in person, telephone, and provider referred recruitment. This pilot study examined the success of three recruitment strategies using 94 patients eligible for CCM services in a rural health clinic. The primary outcome was successful enrollment in the CCM program with differences in recruitment strategy enrollment success examined using a Chi-square test. Overall, 42 of 94 patients (45%) were successfully enrolled in the CCM program with no statistical difference appreciated between telephone, in person, and provider referred recruitment. Nearly 33% (14/42) of patients enrolled in person, 40% (17/42) enrolled via telephone, and 26% (11/42) enrolled when referred from a provider. Ten patients (11%) declined enrollment outright. The remaining 42 patients were hesitant to enroll and requested follow up. In conclusion, there was no statistical difference in CCM enrollment success with in person, telephone, or provider referred recruitment, although more patients were enrolled via telephone than with the other two strategies. Pharmacists implementing new CCM programs may tailor their recruitment and enrollment strategy to suit their specific needs.</p> 2022-11-28T00:00:00-06:00 Copyright (c) 2022 Anastasia B. Jenkins, Elizabeth Holley, Cory Rogers, Natalie Montgomery, Adam N. Pate Phenytoin Toxicity with High Dose, Concomitant Ascorbic Acid Dosing 2022-10-21T13:13:48-05:00 Michael J. Schuh Kevin Mustain Sheena Crosby <p>High dose ascorbic acid may increase risk of phenytoin toxicity. This case report demonstrates high phenytoin levels resulting in adverse drug reactions subsequent to dosing concomitantly with high dose vitamin C, or ascorbic acid (AA), as a precaution against acquiring corona virus (COVID) infection. This patient suffered from a major seizure when he ran out of his phenytoin prescription. Subsequent initiation of phenytoin and later addition of high dose AA resulted in truncal ataxia and falls with bilateral wrist and finger extension weakness<strong>. </strong>Phenytoin and AA were discontinued, and the patient returned to baseline on a new medication regimen of lacosamide and gabapentin without any other major seizures one year later.</p> 2022-12-09T00:00:00-06:00 Copyright (c) 2022 Michael J. Schuh, Kevin Mustain, Sheena Crosby Pharmacogenetic Testing and Therapeutic Drug Monitoring Of Sertraline at a Residential Treatment Center for Children and Adolescents: A Pilot Study 2022-08-29T12:29:27-05:00 Katelyn France David Ammend Jacob Brown <p><strong>Background</strong>: Sertraline is commonly prescribed to children for the treatment of anxiety and major depressive disorder and is metabolized in part by CYP2C19. While dosing recommendations based on CYP2C19 genotype exist, there is sparse data in children on the relationship between sertraline concentrations and CYP2C19 genotype. Additionally, although rarely utilized in the United States, therapeutic drug monitoring can also help to guide dosing. The primary objective of this pilot study was to compare sertraline concentrations with CYP2C19 genotype. Secondary objectives included exploring the feasibility of using pharmacogenetic testing and therapeutic drug monitoring in a residential treatment center for children and adolescents.</p> <p><strong>Methods</strong>: This study was a prospective, open-label study of children prescribed sertraline being treated at a residential treatment center for children and adolescents. Individuals were included if they were &lt; 18 years of age, taking sertraline for at least 2 weeks allowing them to reach steady-state concentrations, being treated through the residential treatment program, and able to understand and speak English.</p> <p><strong>Results</strong>: A total of 20 participants (80% female) completed all study procedures, including pharmacogenetic testing and therapeutic drug monitoring, with an average age of 15.4 years (range: 9-17 years). Forty percent (n=8) of participants had a diagnosis of Generalized Anxiety Disorder, while 30% (n=6) had a diagnosis of Major Depressive Disorder. Overall, average sertraline and desmethylsertraline concentrations were 21.1 ng/ml (range: 1-78 ng/ml) and 52.4 ng/ml (range: 1-258 n/ml). Based on CYP2C19 genotypes, 60% (n=12) were normal metabolizers, 10% (n=2) were intermediate metabolizers, and 30% (n=6) were rapid metabolizers. Daily sertraline dose (mg/day) accounted for a significant amount of the observed variability in sertraline (p&lt;0.0001; r<sup>2</sup>=0.62) and desmethylsertraline concentrations (p&lt;0.001; r<sup>2</sup>=0.45). When comparing weight-based dosing by sertraline and desmethylsertraline concentrations, sertraline daily dose by weight (mg/kg/day) also accounted for a significant amount of the observed variability in sertraline (p&lt;0.0001; r<sup>2</sup>=0.60) and desmethylsertraline (p&lt;0.0001; r<sup>2</sup>=0.59) concentrations. Average daily and weight-based doses for CYP2C19 intermediate, normal, and rapid metabolizers were 75 mg/day, 87.5 mg/day, and 79.2 mg/day and 1.5 mg/kg/day, 1.3 mg/kg/day, and 1.1 mg/kg/day, though these were not significantly different.</p> <p><strong>Conclusion</strong>: This small, pilot study showed sertraline dose to be significantly associated with sertraline and desmethylsertraline concentrations. No differences were noted between CYP2C19 metabolizer groups, likely due to the limited sample size. These results also suggest that ordering pharmacogenetic testing and therapeutic drug monitoring in the setting of a child and adolescent residential treatment center is feasible.</p> 2022-12-15T00:00:00-06:00 Copyright (c) 2022 Katelyn France, David Ammend, Jacob Brown Evaluating COVID-19’s Impact on Patient Access to Care in the Community Pharmacy Setting 2022-07-08T12:29:08-05:00 Huy T. Hoang Dorsa Saghira Mary Finch Jeff Fortner <p><strong>Introduction</strong>: Community pharmacies across the country have been adapting the ways their patients receive medications and prescription information during the COVID-19 pandemic. In order to reduce the risk of COVID-19 infection, the CDC encouraged patients to use pharmacy drive-throughs, curbside pickup, or home delivery services to obtain medications. This research study is one of the first studies to analyze how patients utilize and access Medication Management Services (MMS) in the community pharmacy setting during the COVID-19 pandemic.</p> <p><strong>Objective</strong>: To evaluate changes to patients’ utilization of Medication Management Services in the community pharmacy setting during the COVID-19 pandemic.</p> <p><strong>Methods</strong>: Eligible patients included persons 18 years old and older, and currently taking at least (1) chronic prescription medication in the last three months. Pharmacists were excluded from the study.</p> <p>Telephonic or video interviews were conducted with patients from community pharmacy settings. Descriptive statistics were used to summarize patient characteristics and responses to select interview questions. A qualitative thematic analysis was conducted with data collected from open-ended interview questions.</p> <p><strong>Results</strong>: Thirty-five patients participated in interviews. Patients reported increased use of telehealth and technology, increases in quantity or days supply of medications, initiation of mail delivery services, and curbside pick-up. Five (14.3%) patients used telehealth or increased their technology usage due to the pandemic. Seven (20%) patients reported they were more proactive in refilling their medications. Eleven (31.4%) patients indicated they were currently using a prescription delivery service and were likely to continue the service. On the contrary, five (14.3%) patients experienced decreased healthcare professional interactions, while 3 (8.6%) patients encountered slowed pharmacy processing and 2 (5.7%) faced technology barriers. However, 58% of patients reported no changes to the way they utilized MMS during COVID-19.</p> <p><strong>Conclusion: </strong>Like many other healthcare providers, the COVID-19 pandemic caused a shift in how community pharmacies care for the patients they serve. This study identified various changes in how the pandemic impacted the way patients accessed and utilized community pharmacy services. These findings can serve to inform community pharmacies on how to best serve their patients during this and future pandemic.</p> 2022-12-29T00:00:00-06:00 Copyright (c) 2022 Huy T. Hoang, Dorsa Saghira, Mary Finch, Jeff Fortner Perspectives about Spiritual Care in Pharmacy Practice: A Community-based Survey 2022-10-06T11:05:00-05:00 Paul Gavaza Bhaktidevi M. Rawal Elizabeth Johnston Taylor <p><strong>Background: </strong>Addressing religious and spiritual needs are important components of holistic healthcare. Little is known about the general public’s perspectives about pharmacists providing spiritual care (SC).</p> <p><strong>Objectives: </strong>To explore how community members perceive, experience, and desire pharmacist-provided SC.</p> <p><strong>Method:</strong> IRB approval was obtained for this observational, cross-sectional study. Adults receiving COVID-19 vaccinations at an immunization clinic completed an investigator-designed 33-item online survey. The survey measured respondents’ perspectives about and experiences with pharmacist-provided SC, as well as demographic characteristics.</p> <p><strong>Results:</strong> Of the respondents (n = 261), 57% were female and 46% were Hispanic/Latino. Most (59%) agreed that their religion/spirituality would be important to them if they were ill; 64% also agreed that it would be helpful for a pharmacist to know about patients’ religious/spiritual beliefs pertaining to their healthcare, and 60% agreed that pharmacists should provide SC to patients who request it. While 96% indicated that they had never talked to a pharmacist about a spiritual or religious matter related to their health or medication, 96% also indicated that no pharmacist had asked to pray with them. These results are contextualized perhaps by the finding that 76% reported having no professional relationship with a pharmacist.</p> <p><strong>Conclusion:</strong> Respondents often reported an openness to receiving SC from pharmacists. Most respondents, however, had not received SC from a pharmacist. Future studies should be conducted to better understand patient preferences for pharmacist-provided SC.</p> 2023-01-03T00:00:00-06:00 Copyright (c) 2023 Paul Gavaza, Bhaktidevi M. Rawal, Elizabeth Johnston Taylor Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process 2022-10-05T10:02:48-05:00 Simroop Ladhar Karen Dahri Colleen Inglis Amanda Sambrielaz Haider Raza Michael Legal <p><strong>Background: </strong>Transitions of care represent a vulnerable time for patients where unintended therapeutic changes are common and inadequate communication of information frequently results in medication errors. Pharmacists have a large impact on the success of patients during these care transitions; however, their role and experiences are largely absent from the literature.</p> <p><strong>Objectives:</strong> The purpose of this study was to gain a greater understanding of British Columbian hospital pharmacists’ perceptions of the hospital discharge process and their role in it.</p> <p><strong>Methods:</strong> A qualitative study utilizing focus groups and key informant interviews of British Columbian hospital pharmacists was conducted from April to May 2021. Questions asked during interviews were developed following a detailed literature search and included questions regarding the use of frequently studied interventions. Interview sessions were transcribed and then thematically analyzed using both NVivo software and manual coding.</p> <p><strong>Results:</strong> Three focus groups with a total of 20 participants and one key informant interview were conducted. Six themes were identified through data analysis: (1) overall perspectives; (2) important roles of pharmacists in discharges; (3) patient education; (4) barriers to optimal discharges; (5) solutions to current barriers; and (6) prioritization.</p> <p><strong>Conclusions and Relevance:</strong> Pharmacists play a vital role in patient discharges but due to limited resources and inadequate staffing models they are often unable to be optimally involved. Understanding the thoughts and perceptions of pharmacists on the discharge process can help us better allocate limited resources to ensure patients receive optimal care.</p> 2023-01-11T00:00:00-06:00 Copyright (c) 2023 Simroop Ladhar, Karen Dahri, Colleen Inglis, Amanda Sambrielaz, Haider Raza, Michael Legal