INNOVATIONS in pharmacy https://pubs.lib.umn.edu/index.php/innovations 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. en-US <p>Copyright of content published in <em>INNOVATIONS in pharmacy</em>&nbsp;belongs to the author(s).</p> schom010@umn.edu (Jon Schommer, Ph.D.) libpubs@umn.edu (Emma Molls) Mon, 24 Jan 2022 09:00:46 -0600 OJS 3.3.0.7 http://blogs.law.harvard.edu/tech/rss 60 Perspectives of Pharmacists on the Structure, Decision-Making, and Communication Practices of Multidisciplinary Cancer Teams in Alabama https://pubs.lib.umn.edu/index.php/innovations/article/view/4298 <p><strong>Introduction:</strong> A multidisciplinary team (MDT) approach within cancer care settings is increasingly being adopted to improve patient outcomes due to the rising complexity of diagnosis and treatment. This study aims to explore the perspective of pharmacists on the structure, decision-making process, and communication practices of cancer MDTs.</p> <p><strong>Methods:</strong> A 25‐item online questionnaire was distributed to oncology‐related clinical pharmacists in Alabama. Data were analyzed using descriptive statistics.</p> <p><strong>Results:</strong> A total of 15 pharmacists completed the survey. More than half of the respondents reported that MDT meetings were held mostly in person on a set schedule. While physicians primarily facilitated the meetings, patients and/or their caregivers were largely not invited to participate in them. The treating physician oversaw delivering and update to the patient and/or their caregivers after the MDT meetings. Most respondents indicated that positron emission and computed tomography were the most common sources of information available at initial case presentations. Overall, respondents strongly agreed that they felt comfortable sharing their opinions with others health professionals during MDT meetings.</p> <p><strong>Conclusions:</strong> This study provides evidence that oncology pharmacists are involved in MDT decision-making processes and communications but suggests the need to promote conditions to further their participation.</p> Moano Gnagna-Waka, Georges Adunlin, Katie Boyd, Patricia Jumbo-Lucioni, Bolanle Bolaji , Matthew Asare Copyright (c) 2022 Moano Gnagna-Waka, Georges Adunlin, Katie Boyd, Patricia Jumbo-Lucioni, Bolanle Bolaji , Matthew Asare https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4298 Mon, 24 Jan 2022 00:00:00 -0600 Isolated Nail Pigmentation Induced by Minocycline: A Case Report https://pubs.lib.umn.edu/index.php/innovations/article/view/4493 <p>Isolated pigmentation of the nails induced by minocycline therapy is an uncommon occurrence that has only been reported in a handful of cases. In the reported cases of isolated nail discoloration, it has been suggested that nail discoloration may occur preceding other sites of pigmentary changes. As certain types of minocycline-induced pigmentation can be permanent, it is important for clinicians to be aware of this association and discontinue therapy as soon as pigmentary changes are noticed. In this report, we present a case of isolated nail discoloration in the setting of prolonged minocycline therapy for the treatment of rosacea.</p> Abigale Clark, Austin Ambur, Rajiv Nathoo Copyright (c) 2022 Abigale Clark, Austin Ambur, Rajiv Nathoo https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4493 Mon, 24 Jan 2022 00:00:00 -0600 The State of Pharmaceutical Manufacturing in the Democratic Republic of Congo: The Journey so Far https://pubs.lib.umn.edu/index.php/innovations/article/view/4466 <p>Despite a population of over 89 million people, the Democratic Republic of Congo (DRC) has just 30 local pharmaceutical manufacturers (DRC) with the majority of manufacturers based in Kinshasa, the capital city. Of the total number of pharmaceutical products sold in the DRC, just 10% accounts for those manufactured locally. The DRC remains dependent on other countries such as China and India for the supply of active pharmaceutical ingredients (APIs) -thus, local pharmaceutical manufacturing is therefore reliant on imported commodities and industrial machinery. Given the relevance of the pharmaceutical industry, it is vital to pay careful attention to the problems affecting it. Here, we assess the current situation of pharmaceutical manufacturing in the DRC, examine current challenges, and provide solutions for future development.</p> Melody Okereke Copyright (c) 2022 Melody Okereke https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4466 Mon, 24 Jan 2022 00:00:00 -0600 A Portrait of the Pharmacy Profession Globally: Pharmacist Universal Professional Identity and Establishment of Global Pharmacy Council https://pubs.lib.umn.edu/index.php/innovations/article/view/4502 <p>The roles of pharmacists are transforming throughout history and modern pharmacist has a crucial role in ensuring the efficacy and safety of applied drugs. It is a wonder that the pharmacy profession is still being viewed through an antiquated lens that is inconsistent with the diversity and extent of pharmacists’ current scope of practice. There is still much debate in the academic as well as the policy literature about the role of pharmacists and their unique contribution to healthcare. However, pharmacists have been variously characterized as makers of medicines, as pill pushers, pill counters, and bottle labelers, as managers, and as entrepreneurs. Given this variety of roles, the ‘professional identity’ of pharmacists could be viewed as problematic or confused. Having a clear professional identity provides a sense of worth, belonging, or purpose for the individual as well as the group and if that identity is unambiguous then the profession also becomes clearer and more focused. Thus, the purpose of this article was to provide an idea of the universal professional identity of pharmacists as healthcare practitioners’ under the Global Pharmacy Council (GPC). This GPC will enhance the impact of the profession of pharmacy on people’s lives in the context of healthcare trends.</p> Muhammad Ahmer Raza, Shireez Aziz, Misbah Noree, Irfan Anjum, Shahid Masood Raza Copyright (c) 2022 Muhammad Ahmer Raza, Shireez Aziz, Misbah Noree, Irfan Anjum, Shahid Masood Raza https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4502 Tue, 25 Jan 2022 00:00:00 -0600 Assessing Willingness of Patients with Diabetes to Attend Pharmacist-Led Structured and Patient Specific Diabetes Self-Management Education https://pubs.lib.umn.edu/index.php/innovations/article/view/4429 <p><strong>Background: </strong>The American Diabetes Association recommends that people with diabetes should participate in diabetes self-management education, however data shows that many patients do not attend educational classes.</p> <p><strong>Objectives: </strong>To examine the views of patients with diabetes who utilize services at an independent pharmacy in Richmond, Virginia regarding their (1) interest in attending diabetes self-management education and support (DSMES) services, (2) perceptions of a pharmacist leading DSMES services, (3) willingness to pay for DSMES services, and (4) relationship between self-reported diabetes management status with their willingness to attend DSMES services.</p> <p><strong>Methods: </strong>A qualitative survey was administered over five months to patients with diabetes at an independent community pharmacy in Richmond, VA. The survey included 35 questions in a mixed format of Likert scale, dichotomous, and fill in the blank. Survey data was analyzed using univariate, bivariate, and/or multivariate analysis using SAS 9.4.</p> <p><strong>Results: </strong>Twenty seven surveys were completed, 15% response rate. Patients were female (56.7%) with an average age of 69 ± 10.8 years. Caucasian race accounted for 90% of patients, 6.7% reported Black or African American, the remainder responded “other”. Patients agreed they were interested in attending individual virtual and in person DSMES sessions with a rate of 52% and 87%, respectively. When asked about the full service of 9 group sessions, 33% responded disagree and 30% reported agree. 52% of patients reported belief that pharmacists had the knowledge to lead sessions. When asked about willingness to pay, patients mostly selected the lowest cost option ($25 – $35).</p> <p><strong>Conclusion: </strong>Patients with diabetes are willing to participate in DSMES services and believe pharmacists can lead the sessions. It is important to continue to advocate for DSMES services so patients can understand the full benefits of the program and receive the best possible care.</p> Miranda Moore, Joseph Jadallah, Pramit Nadpara, Jean-Venable R. Goode Copyright (c) 2022 Miranda Moore, Joseph Jadallah, Pramit Nadpara, Jean-Venable R. Goode https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4429 Mon, 14 Feb 2022 00:00:00 -0600 Assessment of Direct Oral Anticoagulant Use at a Community Teaching Hospital https://pubs.lib.umn.edu/index.php/innovations/article/view/4459 <p>Direct oral anticoagulants (DOACs) have become popular choices for both the treatment and prevention of thromboembolic events. However, these agents pose additional risks to patients due to complex dosing, insufficient monitoring, and inconsistent patient compliance. This study evaluates the appropriateness of DOAC prescribing for patients who received an order for apixaban or rivaroxaban over a 6-month period. The primary outcome is percentage of inappropriately prescribed DOAC regimens. Secondary outcomes include an effectiveness endpoint of stroke or embolism and a safety endpoint of major bleeding documented during or within 60 days of the initial visit as well as number of pharmacist clinical interventions. DOAC orders were appropriate 73% of the time. Of the 27% of inappropriate orders, approximately half were apixaban and half were rivaroxaban. The most common reason for an inappropriate order for apixaban was due to atrial fibrillation dosing, and the most common reason for an inappropriate rivaroxaban order was due to dose-indication mismatch. There were 30 pharmacist clinical interventions on DOAC orders that were documented during the 6-month period, and the most common reason for a pharmacist intervention was duplication with another anticoagulant. </p> Alaina Van Dyke, Doug Carroll Copyright (c) 2022 Alaina Van Dyke, Doug Carroll https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4459 Mon, 14 Feb 2022 00:00:00 -0600 Medical Use of Cannabis in Africa: The Pharmacists’ Perspective https://pubs.lib.umn.edu/index.php/innovations/article/view/4430 <p>Cannabis is indigenous to many African countries. Despite this, the legalization of cannabis for industrial, medical, and economic purposes is not uniform. However, there is a growing interest in cannabis use for medical purposes in Africa. Pharmacists are best equipped to provide clinical advice and oversight in the safe management, production, and dispensing of medical cannabis on the continent. In this article, we share our perception as pharmacists regarding the medical use of cannabis and the possible roles of pharmacists in maximizing its use in Africa. </p> Yusuff Adebisi, Damilola Olaoye Copyright (c) 2022 Yusuff Adebisi, Damilola Olaoye https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4430 Thu, 24 Feb 2022 00:00:00 -0600 An Evaluation of Local Pharmaceutical Manufacturing in Zimbabwe: How Prepared is Zimbabwe to Produce COVID-19 Vaccines? https://pubs.lib.umn.edu/index.php/innovations/article/view/4656 <p>Globally, the COVID-19 pandemic has had a significant impact, given the rise in the demand for novel therapeutics such as vaccines that can be used in the treatment of COVID-19 patients. Compared to other regions of the world, gross vaccine inequity exists in Africa due to several factors tied to the acute lack of vaccines in the region. As a result, efforts are currently being made to ramp up the production of COVID-19 vaccines in the region. However, there are concerns that most countries in Africa lack the adequate pharmaceutical manufacturing capacity required to produce COVID-19 vaccines, and Zimbabwe is not an exception. This article, therefore, aims to evaluate the preparedness and readiness efforts of the Zimbabwean pharmaceutical industry in the production of COVID-19 vaccines.</p> Melody Okereke, Hope Mufaro Mashavakure, Muhsinah Adesewa Abdulwasiu Copyright (c) 2022 Melody Okereke, Hope Mufaro Mashavakure, Muhsinah Adesewa Abdulwasiu https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4656 Tue, 22 Mar 2022 00:00:00 -0500 Pharmacist-Physician Split-Shared Visits in a Federally Qualified Health Center: Lessons Learned from a Novel Reimbursement Model using Telehealth https://pubs.lib.umn.edu/index.php/innovations/article/view/4451 <p><strong>Introduction</strong>: The Federally Qualified Health Center (FQHC) setting poses unique challenges to reimbursement of services provided by ambulatory care pharmacists; however, recent changes to telemedicine reimbursement have created new opportunities to help overcome these challenges. This article describes the experience and outcomes of the implementation of a novel, pharmacist-physician split-shared telehealth model at AltaMed Medical Group, a large, multi-site FQHC in Los Angeles and Orange counties. </p> <p><strong>Program Development and Implementation</strong>: A pilot program for pharmacist-physician split shared tele-visits was launched at one clinic site with one clinical pharmacist and has since been expanded to a total of 6 sites and 5 clinical pharmacists. Prior to this program, clinical pharmacists saw patients for diabetes mellitus (DM) video-conference disease management appointments. With the launch of the pilot program, additional steps were added to pre-existing workflows to create a model in which visits with the clinical pharmacists were followed by an “enhanced visit” with an eligible, billable clinic provider.</p> <p><strong>Outcomes</strong>: Average A1c change for all patients in the split-shared model was -1.5%, and average A1c change for program graduates from enrollment through graduation was -3.8%. Evidence from similar services have also been associated with significant increases in revenue from a split-shared model, indicating this design can be a viable option for financial justification of ambulatory care pharmacy services.</p> <p><strong>Conclusion</strong>: In the setting of current limitations, we advocate for increased utilization of shared visits and split-shared visits as a viable method to generate revenue and aid in the justification of clinical pharmacy services.</p> Nada M. Abou-Karam, Melisssa E. Jump, Jingying Jiao, Andrew N. Schmelz Copyright (c) 2022 Nada M. Abou-Karam, Melisssa E. Jump, Jingying Jiao, Andrew N. Schmelz https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4451 Tue, 29 Mar 2022 00:00:00 -0500 Implementation of a Targeted Inhaled Corticosteroid De-Escalation Process in Patients with Chronic Obstructive Pulmonary Disease in the Primary Care Setting https://pubs.lib.umn.edu/index.php/innovations/article/view/4349 <p><strong>Purpose:</strong> To evaluate the feasibility and success of a pharmacist-led, targeted inhaled corticosteroid (ICS) de-escalation process in patients with chronic obstructive pulmonary disease (COPD) where the risks of ICS therapy outweigh the potential benefits.</p> <p><strong>Methods:</strong> A population health data management tool was leveraged to identify patients who may qualify for ICS de-escalation. Primary care pharmacists clinically reviewed and subsequently contacted patients who were determined to be appropriate candidates. After discussion on the risks and benefits of ICS therapy, a stepwise algorithm was utilized to assist with ICS de-escalation and optimization of bronchodilator therapy. Outcomes analyzed include the proportion of patients for whom ICS was de-escalated, patient acceptability of the intervention, time taken to complete the intervention, barriers to implementation, and the number of additional interventions made by pharmacists.</p> <p><strong>Results: </strong>Of the 126 patients originally identified as potential candidates, 58 (46.0%) were deemed appropriate to proceed with ICS <br />de-escalation and successfully contacted by a pharmacist. Of these patients, 49 (84.5%) were agreeable and ultimately 42 were successfully de-escalated with 37 patients maintained off ICS. The average time required for an encounter was 15.8 minutes.</p> <p><strong>Conclusion: </strong>There is utility in a pharmacist-driven, targeted ICS de-escalation process to facilitate meeting guideline-directed medication therapy goals in patients with COPD, granted the availability of efficient tools to assist in identifying patients that qualify. Such a targeted approach increases pharmacist involvement in medication management of COPD and can expand the primary care pharmacy practice.</p> Nicole M. Hahn, Michael W. Nagy Copyright (c) 2022 Nicole M. Hahn, Michael W. Nagy https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4349 Tue, 29 Mar 2022 00:00:00 -0500 Impact of a Pharmacist-Led Warfarin to Direct Oral Anticoagulant Conversion Initiative during the COVID-19 Pandemic https://pubs.lib.umn.edu/index.php/innovations/article/view/4491 <p><strong>Purpose: </strong>To assess the impact of a pharmacist-led warfarin to DOAC conversion initiative during the COVID-19 pandemic.</p> <p><strong>Methods: </strong>Patients who were prescribed warfarin and followed with the anticoagulation clinic for INR monitoring were assessed by outpatient clinical pharmacists as potential candidates for transition to DOACs from March-August 2020.</p> <p><strong>Results: </strong>530 patients were assessed for transition to DOACs, of which 373 (70.4%) were deemed by clinical pharmacists to be candidates for DOACs. Of the patients who were candidates for DOACs, 66 (17.7%) were transitioned from warfarin to a DOAC. Of the patients who transitioned to a DOAC, 59 (89.4%) remained on a DOAC after one year.</p> <p><strong>Conclusion: </strong>Outpatient clinical pharmacists are an effective resource to help identify patients who are candidates for DOACs and assist with transition from warfarin. Further, high persistence rates with DOAC therapy after one year demonstrate the positive impact of the clinical pharmacist on medication adherence.</p> Kelsey Mews, Audrey Umbreit, Emily Holm, Kelsie Davis, Ellen Kelly, Carson Reinhardt, Allison Young, Joseph Flynn Copyright (c) 2022 Kelsey Mews, Audrey Umbreit, Emily Holm, Kelsie Davis, Ellen Kelly, Carson Reinhardt, Allison Young, Joseph Flynn https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4491 Tue, 29 Mar 2022 00:00:00 -0500 Shifts in Pharmacists’ Responsibilities in Family Medicine Residency Programs during COVID-19 https://pubs.lib.umn.edu/index.php/innovations/article/view/4559 <p><strong>Background</strong>: The role of clinical pharmacists in family medicine residency programs (FMRPs) has become increasingly commonplace in the last several years, with mixed responsibilities, however largely involving teaching and patient care. The COVID-19 pandemic affected all facets of healthcare, pharmacists included. Assessment of the impact of COVID-19 on the role of the pharmacist in FMRPs is needed.</p> <p><strong>Methods</strong>: A survey tool was developed and distributed through two national listservs clinical pharmacists in FMRPs commonly subscribe to.</p> <p><strong>Results</strong>: A total of 32 responses were received. The majority of pharmacist participants indicated no change in their overall time allocation to the FMRP. Patient care was affected by transitions to virtual or remote care for those in the outpatient setting, which in some cases were sustained changes. Teaching responsibilities increased for the majority, largely impacted by the need to transition to virtual platforms. Barriers to relationship development resulted from both of these transitions. Innovations and positive results were reported by participants in patient care, teaching, and research.</p> <p><strong>Conclusions</strong>: These results highlight the many silver linings of the COVID-19 pandemic. The new challenges, such as the increased teaching need, use of virtual platforms and using creative ways to find connections and build relationships in an ongoing, semi-virtual world, are opportunities for continued innovation for clinical pharmacists as they fit within our strengths and scope within FMRPs.</p> Katherine Montag Schafer, Ila Harris, Jody Lounsbery, Ann M. Philbrick, Jean Moon Copyright (c) 2022 Katherine Montag Schafer, Ila Harris, Jody Lounsbery, Ann M. Philbrick, Jean Moon https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4559 Wed, 06 Apr 2022 00:00:00 -0500 Sedative Choice: The Chilling Confounder to Targeted Temperature Management https://pubs.lib.umn.edu/index.php/innovations/article/view/4501 <p>Targeted temperature management (TTM) is a technique used in adults who lack a meaningful response after the return of spontaneous circulation following cardiac arrest (CA). The implementation of TTM is believed to improve neurological outcomes by decreasing cerebral metabolism, reducing apoptosis, and lowering oxygen demand. While this technique is recommended as a part of advanced cardiovascular life support (ACLS), there is a lack of consistency regarding drug choice and depth of sedation in TTM. In this report, the authors provide a review of the myriad of regimens outlined in research protocols and current guidelines to stimulate discussion and promote further studies pertaining to sedation strategies in TTM. Through this call to action, the ultimate goal is to develop a uniform approach to bedside practice.</p> W. Anthony Hawkins, Aliya Abdulla, Xiaodong Hua, Andrea Sikora Copyright (c) 2022 W. Anthony Hawkins, Aliya Abdulla, Xiaodong Hua, Andrea Sikora https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4501 Thu, 07 Apr 2022 00:00:00 -0500 Improving Appropriate Prescribing For Geriatric Patients Using a Clinical Decision Support System https://pubs.lib.umn.edu/index.php/innovations/article/view/4514 <p><strong>Purpose: </strong>Polypharmacy is a known risk factor for potentially inappropriate prescribing. Recently there is an increasing interest in clinical decision support systems (CDSS) to improve prescribing. The objective of this study was to evaluate the impact of a CDSS, with the START-STOPP criteria as main content in the setting of a geriatric ward. Endpoints were 1) appropriateness of prescribing and 2) acceptance rate of recommendations.</p> <p><strong>Methods: </strong>This prospective study comparing the use of a CDSS with usual care involved patients admitted to geriatric wards in two teaching hospitals in the Netherlands. Patients were included from January to May 2017. The medications of 64 patients in the first six weeks was assessed according to the current standard, whereas the medications of 61 patients in the second six weeks were also assessed by using a CDSS. Medication appropriateness was assessed with the Medication Appropriateness Index (MAI).</p> <p><strong>Results: </strong>The medications of 125 patients (median age 83 years) were reviewed. In both the usual care group and the intervention group MAI scores decreased significantly from admission to discharge (within group analyses, p&lt;0.001). This effect was significantly larger in the intervention group (p&lt;0.05). MAI scores at discharge in the usual care group and the intervention group were respectively 9.95±6.70 and 7.26±5.07. The CDSS generated 193 recommendations, of which 71 concerned START criteria, 45 STOPP criteria, and 77 potential interactions. Overall, 31.6% of the recommendations were accepted.</p> <p><strong>Conclusion: </strong>This study shows that a CDSS to improve prescribing has additional value in the setting of a geriatric ward. Almost one third of the software-generated recommendations were interpreted as clinically relevant and accepted, on average one per patient.</p> Floor van den Hanenberg, Valentina Poetsema, Carolina JPW Keijsers , Jeroen JMA Hendrikx, Jos van Campen, Michiel C Meulendijk , Jelle Tichelaar, Michiel A van Agtmael Copyright (c) 2022 Floor van den Hanenberg, Valentina Poetsema, Carolina JPW Keijsers , Jeroen JMA Hendrikx, Jos van Campen, Michiel C Meulendijk , Jelle Tichelaar, Michiel A van Agtmael https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4514 Thu, 14 Apr 2022 00:00:00 -0500 Pharmacist-led Smoking-Cessation Services in the United States – A Multijurisdictional Legal Analysis https://pubs.lib.umn.edu/index.php/innovations/article/view/4643 <p> A challenge presents itself when pharmacy students and pharmacists have the knowledge, skills, and abilities to provide optimal patient care, which can prevent the healthcare industry from incurring expenditures reaching billions of dollars annually from chronic and acute disease state management, yet due to the lack of statutory or regulatory authority to independently prescribe and dispense smoking cessation products they are unable to tap into this potential.</p> <p> Prescriptive authority of pharmacists is not a novel concept; however, State Legislatures and Boards of Pharmacy have been slow to expand upon the pharmacist’s scope of practice to include this authority. As a consequence, this inaction hinders the opportunity of almost 21.5 million patients, who attempt to quit smoking annually, the ability to access a U.S. Food and Drug Administration approved, evidence-based medication-assisted or nicotine replacement therapy prescribed by a pharmacist.<sup>2</sup> Current legislative efforts, laws, and regulations regarding a pharmacist’s prescriptive authority for tobacco cessation therapy vary greatly amongst the states and do not include reference to e-cigarettes or electronic nicotine delivery systems (e.g., e-cigs, vape pens, vapes, mods, etc.). Additionally, pharmacists are often required to practice under a statewide protocol or enter into a collaborative practice agreement (“CPA”) with a designated physician, which are often complex and create significant barriers for the pharmacist to practice at the top of their license and for the benefit of the patient. This legal and regulatory study reveals the following: 1) Those States that have addressed or attempted to address the pharmacist’s prescriptive authority for tobacco cessation therapy, 2) the authority to independently prescribe vs. practice under a statewide protocol, 3) the products able to be prescriber or dispensed under the pharmacist’s prescriptive authority or statewide protocol, and 4) the guidelines and/or protocols referenced within their respective State laws and regulations. States and their residents would benefit greatly from amending their laws and regulations to expand upon the pharmacist’s prescriptive authority, granting them the ability to help their communities by performing services they are highly trained to perform.</p> Landon S. Bordner, Joseph Lavino Copyright (c) 2022 Landon S. Bordner, Joseph Lavino https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4643 Wed, 11 May 2022 00:00:00 -0500 More Than Our Enemy: Making Space for the Microbiome in Pharmacy Education https://pubs.lib.umn.edu/index.php/innovations/article/view/4553 <p>The microbiome is the collection of commensal microorganisms along with their genomes inhabiting the human body. Despite the many known beneficial effects of these microbes on human health, the 2016 ACPE Standards for Doctor of Pharmacy curricula describe Medical Microbiology in Appendix 1 with a pathogen-centered focus. Over the last twenty years, evolving biotechnology has enabled a deeper understanding of the microbiome in the context of both wellness and disease. Retail stores are allocating increasing shelf space to commercial probiotic products, while the approach to PharmD training on the selection and use of these natural care products remains static, creating a disproportionate footprint between PharmD curricula and consumer markets. Looking to the future of patient care, we brief pharmacy educators on the current evidence and invite discussion around a proposed revision to the 2025 ACPE Standards that would add language recognizing the beneficial role of the commensal microbiota and expanding therapeutic applications of microbiome supplementation. We suggest a variety of opportunities within Doctor of Pharmacy curricula as leverage points for including relevant aspects of the microbiome in the training of future pharmacists.</p> Sarah P Collier, Abby J Weldon, Jessica L Johnson Copyright (c) 2022 Sarah P Collier, Abby J Weldon, Jessica L Johnson https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4553 Thu, 03 Mar 2022 00:00:00 -0600 Traditional Lecture versus Case-Based Learning in a Therapeutic Drug Monitoring Course within an Integrated Pharmacy Curriculum https://pubs.lib.umn.edu/index.php/innovations/article/view/4035 <p><strong>Background</strong>: Case-based learning has been shown to increase student perception and performance in multiple topics in pharmacy education. However, no studies have evaluated the impact of virtual patients and case-based learning on student knowledge and knowledge retention of therapeutic drug monitoring and dosing.</p> <p><strong>Innovation</strong>: Due to a curriculum overhaul promoting integration and application-based learning, the traditional third-year (P3) therapeutic drug monitoring course was reduced from four (4) credit hours to two (2), in order to add time to pharmacotherapy and skills labs. In order to adapt to this change, the course was shifted to a case-based learning format utilizing virtual patients within a simulated electronic health record (EHR) where the course grade distribution shifted in favor of patient cases versus exam questions. An analysis of student knowledge and knowledge retention of antibiotic dosing and monitoring was conducted comparing students who completed the traditional course versus those who completed the case-based course.</p> <p><strong>Findings</strong>: Despite the decrease in credit hours, there was no significant difference shown in the initial knowledge assessment between the traditional and case-based courses (87.0 vs 85.5%). Knowledge retention actually improved in the students who completed the case-based course (78.1% vs 82.5%).</p> <p><strong>Conclusion</strong>: Utilizing case-based instruction to teach antibiotic dosing and monitoring was successful in preparing students for these skills during their experiential rotations. Even though students had half the instruction time, they were able to perform calculations and retain knowledge as well as students in the traditional curriculum.</p> Riley D. Bowers, C. Scott Asbill Copyright (c) 2022 Riley D. Bowers, C. Scott Asbill https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4035 Fri, 29 Apr 2022 00:00:00 -0500 The Evaluation of Pharmaceutical Packaging Pictograms via Eye Tracking Technique https://pubs.lib.umn.edu/index.php/innovations/article/view/4307 <p><strong>Background</strong>: Various visual tools are used to improve medication adherence in communication with the patient. Pharmaceutical pictograms are one such tool utilized within this communication process.</p> <p><strong>Objective</strong>: The aim of this study is to investigate the eye movement of the participants and to recommend the most suitable location of pictograms on pharmaceutical packaging accordingly. It also aims to show whether there is a significant correlation between the effectiveness of pictograms and the health literacy, age, and gender of the participant.</p> <p><strong>Methods</strong>: Forty-two participants were exposed to sixty stimuli showing four different pharmaceutical packages as an on-screen slide show. Participants were asked what they understood from the pictograms on the packaging, and their eye movements were examined using eye tracking to determine heat maps and areas of interest, and to measure the time to first fixation, total fixation duration, and percentage fixated.</p> <p><strong>Results</strong>: The study revealed that the understanding level of the pictograms was determined at between 11.9 % and 71.43 %. Among the pictograms, only a small percentage 13% – namely numbers 12 and 13 which were prepared and validated by the FIP, achieved a score of 67%, the minimum level of comprehension in accordance with ISO 3684. We observed that participants fixated at least once on the pictograms up to 95% of the time. The pictograms were found to be most easily noticed at the center with a secondary focus area towards center-right parts of the packaging. Vertical design was highly engaging for participants regardless of health literacy. The significant relationship was found between the understanding of the pictograms and gender when mean values are examined. However, no significant relationship was between health literacy and pictogram comprehension level.</p> <p><strong>Conclusions</strong>: This is the first study to have used eye tracking to analyze pictograms added to real pharmaceutical packaging on the market. Its findings can guide pharmaceutical companies to design their packaging in a way that prioritizes patient safety, and to place critical pictograms more effectively. These results can be adapted medication label design in hospitals to promote appropriate use. Studies to improve patient adherence by using pictograms should be diversified.</p> Merve Memişoğlu, Yener Yener Girişken Copyright (c) 2022 Merve Memişoğlu, Yener Yener Girişken https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4307 Fri, 04 Feb 2022 00:00:00 -0600 Enhancing Student Confidence in Diabetes Management Skills Through Pharmacist-Run Group Classes in a Community Library https://pubs.lib.umn.edu/index.php/innovations/article/view/4332 <p><strong>Purpose</strong>: To evaluate student pharmacists’ confidence after providing education within diabetes groups in a non-medical community setting.</p> <p><strong>Program Description</strong>: Three 8-week diabetes group courses were developed and executed within a local public library. The courses aimed to teach participants with diabetes how to effectively manage their medical condition to prevent future related complications. Student pharmacists were responsible for checking and recording the patients’ vitals, assisting in answering questions posed by the participants throughout the session, presenting different medication information each week, and creating a brochure which described the highlights of the specific week’s medication class. The student pharmacists were then surveyed regarding their confidence level in providing diabetes education in the future as well as their experience of working within these groups.</p> <p><strong>Summary</strong>: Seventeen student pharmacists participated in three 8-week sessions. The majority of the student pharmacists reported increased confidence in being able to provide diabetes education as well as newfound empathy for persons with diabetes on how to manage their medical condition.</p> Regina Ginzburg, Christine Chim Copyright (c) 2022 Regina Ginzburg, Christine Chim https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4332 Tue, 22 Mar 2022 00:00:00 -0500 The Association of Caregiver Characteristics and Caregivers’ Perceived Difficulty in Medication Management Tasks https://pubs.lib.umn.edu/index.php/innovations/article/view/4523 <p><strong>Background:</strong> Medication management tasks are commonly performed by family caregivers caring for patients with dementia, but caregivers also reported difficulties in performing these tasks.</p> <p><strong>Objectives:</strong> Using the 2017 National Study of Caregiving (NSOC) and the 2017 National Health and Aging Trends Study (NHATS), this study examined the association between caregiver characteristics and caregiver difficulty in performing medication management tasks (e.g., ordering medications, keeping track of medications, giving shots).</p> <p><strong>Methods:</strong> The main independent variable was the number of medication management tasks performed by the caregivers. The dependent variable was difficulty in performing medication management tasks. Other variables of interest included caregiver age, sex, education, co-residence with the care recipient, and use of support services. This study used the Pearlin’s Stress and Coping Model to select other control variables from hundreds of variables contained in the NSOC. A lasso logistic regression model was used to account for the large amount of other control variables.</p> <p><strong>Results:</strong> Caregiver difficulty was found mainly in keeping track of medications or giving shots (42.4%). More medication management tasks were significantly related to caregiver difficulty [OR=2.71; 95% CI (1.84 - 3.99)]. A significant association linking support service use with task difficulty was also observed [OR=1.82; 95% CI (1.06 - 3.13)], which warrants additional research.</p> <p><strong>Conclusions:</strong> Caregiver difficulty was found mainly in keeping track of medications or giving shots. More medication management tasks were significantly related to caregiver difficulty. Since patients with dementia are often on multiple medications, it is crucial to ensure medication management is done correctly to avoid adverse health consequences.</p> Niying Li, Kevin A. Look Copyright (c) 2022 Niying Li, Kevin A. Look https://creativecommons.org/licenses/by-nc/4.0 https://pubs.lib.umn.edu/index.php/innovations/article/view/4523 Wed, 06 Apr 2022 00:00:00 -0500