INNOVATIONS in pharmacy

Implementation of a Student Pharmacist-Led Program to Enhance Health Access in an Arab-American Community Head: Health Program in an Arab-American Community

2023-01-11T13:20:26-06:00

Objectives: Immigration of Arabs to the United States has increased in recent years due to political instability and need for improved access to healthcare. Cardiovascular disease, diabetes, and obesity disproportionally affect Arab Americans. Student pharmacists are well positioned to increase health awareness by providing health screening services and education classes to the Arab immigrant community. This report will describe the development of a student-run Arab American Health Awareness Program (AAHAP) that provides culturally-sensitive community screening services targeting common health disparities seen among Arab-Americans.

Design: Data were collected on the number of patient cardiometabolic screenings, referrals for medical care, and health classes which were performed over the course of 2 years. The practice setting included community centers, faith-based centers, and grocery stores in the Chicago area participating in the AAHAP.

Results: Over the course of two years, eight cardiometabolic screenings and four community health classes were provided to the Arab-American community. Over 100 student pharmacists provided screenings to 929 patients through AAHAP. Twenty percent (n=193) of all patients screened were referred for further medical care. A total of 77% patients were within goal for blood pressure, 82.3% for blood glucose, and 39.4% for BMI. Patients with a known history of hypertension (n=83) or diabetes (n=64) were more likely to have uncontrolled blood pressure (45% vs 11%, p<0.05) or blood glucose (39% vs 14%, p<0.05) compared to patients without a history of these chronic conditions.

Conclusion: Student pharmacists can be drivers for health access through community health programs for ethnically minoritized populations. Development of a health awareness program focused on known health disparities in Arab Americans has provided student pharmacists with opportunities to deliver culturally-sensitive care and medical referral services to an underserved community.

Assessing Perceptions and Medication Disposal Habits in Rural Michigan

2023-04-12T11:41:23-05:00

Background: Inadequate or inappropriate medication disposal is a public health concern that may lead to increased community risk of accidental poisonings, substance misuse, and environmental pollution.

Objective: The study’s primary objective was to assess medication disposal knowledge and practices of Michigan residents living in rural, underserved areas. Secondary objectives included determining baseline perceptions of at-home drug disposal kits and examining the impact of an educational video intervention on at-home drug disposal kit perceptions.

Methods: To measure the objectives, an online 15-question survey was deployed to the general public via convenience sampling from local organizations working with drug disposal. The survey questions assessed medication disposal knowledge and practices in underserved, rural Michigan. Participant responses were assessed categorically and numerically.

Results: Inclusion criteria were met by 97 survey participants. Results indicated that Michigan rural residents, regardless of various demographic factors, would benefit from increased drug disposal education. Specifically, at-home drug disposal kits and medication drop boxes have the highest need for additional education. Perceptions related to home disposal safety and ease of use improved significantly with an educational video intervention.

Conclusion: All rural residents, regardless of demographics, would benefit from increased drug disposal education. A short, educational video can impact thoughts and attitudes related to at-home drug disposal kits. Similar interventions may be successful in other rural, underserved areas.

Identification and Characterization of Workflow Models for Medication Therapy Management in Community Pharmacies

2023-03-17T11:38:24-05:00

Community pharmacists providing medication therapy management (MTM) services report difficulty incorporating MTM services with dispensing and other pharmacy services. A variety of approaches exist due to a lack of an ideal standard for service integration. This study seeks to identify and characterize MTM workflow models in pharmacies of one geographic area of a large community pharmacy chain. Thirteen semi-structured interviews were conducted with pharmacists from thirteen different pharmacies. Interviews were audio-recorded, transcribed, and analyzed for common themes using an inductive qualitative approach. We did not find a high level of MTM task integration into the dispensing workflow in this setting. However, three main strategies used to delegate work of MTM activities were identified and defined: shared teamwork, delegated teamwork, and single delegation. Few MTM tasks were integrated into the dispensing workflow among interviewed pharmacies; most tasks were performed outside of workflow. The most common integration was performing patient interviews at pick up. There were no trends identified among high performing or low performing pharmacies. This work may provide a basis to define workflow models for further research to test implementation strategies within community pharmacies.

Improving Patient Access to Primary Care Providers Using a Pharmacist-Physician Co-Visit Model

2022-10-12T08:42:12-05:00

Background: Implementation of a clinical pharmacist in the primary care setting can offset provider time spent managing chronic diseases using Collaborative Practice Agreements (CPAs). The pharmacist-physician co-visit model presents an opportunity for pharmacists to increase patient access to their primary care provider (PCP). Studies of the co-visit model show that co-visits increase clinic efficiency by allowing the PCP to see additional patients and achieve more health care goals compared with independent visits.

Objectives: The aim of this study was to increase patient access to their PCP by utilizing a pharmacist-physician co-visit model at the Madsen Health Center Family Medicine (MHC FM) Clinic. The primary outcome was to identify the number of co-visits completed compared to the number of possible co-visits, and the number of appointment slots made available. The secondary outcomes were to track the time spent with patients and to obtain provider feedback via a survey.

Methods: The co-visit model was implemented as a 4-month pilot study at the MHC FM Clinic. Complex care appointments lasting 40 minutes were selected based on inclusion and exclusion criteria. Potential co-visit appointments were identified one week prior then provider consent was obtained to change the appointment into two separate 20-minute visits. Schedules were reviewed to determine if the appointment slot opened by the co-visit was filled by another patient. Upon completion of the study, a survey was distributed to providers to collect feedback.

Results: A total of five co-visits were completed out of a possible 19 (26%). All the appointments made available were filled by another patient. On average, the provider and pharmacist spent 15 and 14 minutes with the patient, respectively.

Conclusion: Implementation of the physician-pharmacist co-visit model increased the availability of the PCP to see more patients without disrupting clinic workflow and provider schedules.

High-Evidence, Actionable Phenotype Gene Distribution in a Multispecialty, Tertiary Care Clinic: Potentially Actionable Genes and a Referring Department Profile

2023-04-13T11:29:11-05:00

Background There has been a trend in recent years toward individualized medicine. Pharmacogenomics (PGx) is the use of patient-specific genetic variations to guide medication selection and treatment.

Objective: The primary objective was to characterize the population of referring department patients and identify the number of high-evidence, actionable phenotype (HEAP) genes in this referred population to help guide marketing efforts to the most applicable patient populations and departments.

Practice description: Located in a destination, tertiary care clinic. Providers refer patients to a Pharmacogenomics (PGx) specialist for a comprehensive medication review using their pharmacogenomic results.

Practice Innovation: The practice is innovative because it has been using PGx in the pharmacy and medical practices since 2016 and has been routinely developing and incorporating PGx best practice alerts (BPAs) into the electronic medical record (EMR) since 2020.

Evaluation Methods Genetic results were analyzed from a 27-gene PGx panel test which tests for both pharmacokinetic and pharmacodynamic genes. High-Evidence Actionable Phenotypes (HEAP) are defined as phenotypes with guideline support that may suggest an action by healthcare provider. Low-Evidence Nonactionable Phenotypes (LENP) are defined as phenotypes that do not recommend action.

Results There were 1,236 atypical phenotypes identified in the 154 patients referred. Of the atypical genes, 39.97% were HEAP and 60.03% were LENP. Of the HEAP’s identified, the majority came from CYP2D6, VKORC1, and UGT1A1. At least 1 HEAP was found in 98.7% of patients (n=152).

Conclusion There are a variety of High Evidence Actionable Phenotypes (HEAPs) with a high likelihood of at least one HEAP gene in every patient. These phenotypes can result in serious safety concerns when combined with a medication impacted by one of these HEAP genes. Thus, referral to a pharmacogenomics consultation service may lead to an overall decrease in morbidity and mortality with potential cost avoidance.

Effect of an Innovative Immunization Practice Model to Improve Population Health: Results of the Project IMPACT Immunizations Scaled Demonstration

2023-04-03T10:09:51-05:00

Background: U.S. adult vaccination rates remain low. Community pharmacists have skills and opportunity to improve this shortcoming. This study sought to evaluate an innovative practice model on identification of unmet vaccination needs and their resolution.

Methods: This prospective, multi-site, multi-state, observational study was conducted in 22 community pharmacy practices in Iowa and Washington. Adults receiving influenza vaccination, medication therapy review, prescriptions for diabetes or cardiovascular disease, or another clinical encounter with a participating pharmacist from December 2017 through November 2019 were included. Pharmacists reviewed vaccination forecasts generated by clinical decision support technology based on their state immunization information system (IIS) to identify unmet vaccination needs, educate patients, and improve vaccination rates. The primary outcomes were numbers of vaccination forecast reviews, patients educated, unmet vaccination needs identified and resolved, and vaccinations administered. Secondary outcomes included numbers of vaccination declinations; times a forecasted vaccine was not recommended because a contraindication was identified by the pharmacist; and times the patients declined a forecasted vaccine due to self-reported vaccination despite lack of documentation in the state IIS. Descriptive statistics were calculated.

Results: Pharmacists reviewed vaccination forecasts for 6,234 patients. The vaccination forecasts predicted there were 11,789 vaccinations needed (1.9 per person). 6,405 of the 11,789 unmet vaccination needs (54.3%) were fulfilled during the study period, including 60% on the same day. Of the forecasted needs, 1,085 (9.2%) were found to be previously administered and 59 (0.5%) contraindicated. The remaining patients received information about their personal vaccination needs and recommendations to be vaccinated.

Conclusion: Availability of vaccination histories during patient encounters allowed pharmacists to identify and resolve adult vaccination needs in independent and chain community practice settings.