Pub Date : 2017-02-01DOI: 10.1177/8755122516680621
Nicole A. Fabiilli, M. F. Powers
Objective: To provide an overview of medication reconciliation and to identify opportunities for pharmacy technicians to help improve patient safety and quality of care. Data Sources: Articles were identified through searches conducted in May 2016 by means of MEDLINE/PubMed (2000-2016) using search terms designed to identify English-language articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Additionally, resources on medication reconciliation were used from The Joint Commission, the Institute for Healthcare Improvement, American Pharmacists Association, American Society of Health-System Pharmacists, and Agency for Healthcare Research and Quality. Study Selection and Data Extraction: Articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Data Synthesis: Pharmacy technicians can help pharmacists perform medication reconciliation by taking on 3 specific roles in the process: obtaining preadmission medication history, obtaining relevant patient information from outpatient pharmacies and health care providers, and documenting the compiled medication list. Pharmacy technicians can help resolve discrepancies in medication lists, therefore improving patient care, the ability of pharmacists to communicate with physicians, and thus to clinically intervene in patient care. Furthermore, with proper training, pharmacy technicians may take on expanded roles designed to aid pharmacists with advanced patient care services to eliminate medication discrepancies and improve transition of care. Conclusions: Pharmacy technicians can play a vital role in helping pharmacists to obtain accurate patient medication histories in order to decrease medication discrepancies at transitions of care.
{"title":"Roles for Pharmacy Technicians in Medication Reconciliation During Transitions of Care","authors":"Nicole A. Fabiilli, M. F. Powers","doi":"10.1177/8755122516680621","DOIUrl":"https://doi.org/10.1177/8755122516680621","url":null,"abstract":"Objective: To provide an overview of medication reconciliation and to identify opportunities for pharmacy technicians to help improve patient safety and quality of care. Data Sources: Articles were identified through searches conducted in May 2016 by means of MEDLINE/PubMed (2000-2016) using search terms designed to identify English-language articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Additionally, resources on medication reconciliation were used from The Joint Commission, the Institute for Healthcare Improvement, American Pharmacists Association, American Society of Health-System Pharmacists, and Agency for Healthcare Research and Quality. Study Selection and Data Extraction: Articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Data Synthesis: Pharmacy technicians can help pharmacists perform medication reconciliation by taking on 3 specific roles in the process: obtaining preadmission medication history, obtaining relevant patient information from outpatient pharmacies and health care providers, and documenting the compiled medication list. Pharmacy technicians can help resolve discrepancies in medication lists, therefore improving patient care, the ability of pharmacists to communicate with physicians, and thus to clinically intervene in patient care. Furthermore, with proper training, pharmacy technicians may take on expanded roles designed to aid pharmacists with advanced patient care services to eliminate medication discrepancies and improve transition of care. Conclusions: Pharmacy technicians can play a vital role in helping pharmacists to obtain accurate patient medication histories in order to decrease medication discrepancies at transitions of care.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"11 1","pages":"3 - 7"},"PeriodicalIF":1.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79646867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1177/8755122516681820
S. Mohamed, Tariq Abdul Razak, R. Hashim, Zarina Mohd Ali
Bacground: Atrial fibrillation (AF) patients are 5 times more likely to have stroke than non-AF patients. Stroke prevention (SP) using anticoagulation therapy was recommended in AF patients. Knowledge about AF and SP (KAFSP) is one of the essential factors that can improve patients’ adherence. Yet no established studies were found to determine patients’ KAFSP among AF patients. Objectives: To develop and validate the questionnaire used to measure KAFSP. Methods: A cross-sectional survey was conducted in 4 hospitals in Malaysia. The psychometric of the KAFSP Questionnaire (KAFSP-Q) were performed using content validity index (CVI), internal consistency, test-retest, exploratory factor analysis (EFA), and sensitivity test. Results: A total of 304 patients completed a face-to-face interview to answer the KAFSP-Q. Content and face validity was assessed by 6 experts who are knowledgeable in this field and 15 AF patients, respectively. The KAFSP-Q had good CVI and were well understood by AF patients. The KAFSP-Q also had good reliability and stability with Cronbach’s α of .83 and intraclass correlation coefficient values in test-retest for stability of .9. The EFA results indicated that there were 6 factors with factor loadings above .30. The low correlations between subscales ranged between .01 and .48, which indicated that good discriminant and construct validity were achieved. The scale was able to differentiate between patients’ knowledge levels before and after counseling given. Conclusions: The KAFSP-Q is reliable and valid to measure patients’ KAFSP. Further validation studies are recommended to validate the KAFSP-Q in different contexts and in other languages.
{"title":"Knowledge of Atrial Fibrillation and Stroke Prevention","authors":"S. Mohamed, Tariq Abdul Razak, R. Hashim, Zarina Mohd Ali","doi":"10.1177/8755122516681820","DOIUrl":"https://doi.org/10.1177/8755122516681820","url":null,"abstract":"Bacground: Atrial fibrillation (AF) patients are 5 times more likely to have stroke than non-AF patients. Stroke prevention (SP) using anticoagulation therapy was recommended in AF patients. Knowledge about AF and SP (KAFSP) is one of the essential factors that can improve patients’ adherence. Yet no established studies were found to determine patients’ KAFSP among AF patients. Objectives: To develop and validate the questionnaire used to measure KAFSP. Methods: A cross-sectional survey was conducted in 4 hospitals in Malaysia. The psychometric of the KAFSP Questionnaire (KAFSP-Q) were performed using content validity index (CVI), internal consistency, test-retest, exploratory factor analysis (EFA), and sensitivity test. Results: A total of 304 patients completed a face-to-face interview to answer the KAFSP-Q. Content and face validity was assessed by 6 experts who are knowledgeable in this field and 15 AF patients, respectively. The KAFSP-Q had good CVI and were well understood by AF patients. The KAFSP-Q also had good reliability and stability with Cronbach’s α of .83 and intraclass correlation coefficient values in test-retest for stability of .9. The EFA results indicated that there were 6 factors with factor loadings above .30. The low correlations between subscales ranged between .01 and .48, which indicated that good discriminant and construct validity were achieved. The scale was able to differentiate between patients’ knowledge levels before and after counseling given. Conclusions: The KAFSP-Q is reliable and valid to measure patients’ KAFSP. Further validation studies are recommended to validate the KAFSP-Q in different contexts and in other languages.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"189 1","pages":"31 - 39"},"PeriodicalIF":1.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78067060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/8755122516669379
Leanne Justis, Jeremy Crain, M. Marchetti, K. Hohmeier
Background: Cognitive pharmaceutical services (CPS) provided by pharmacists can improve patient adherence and industry standard performance measures. Community pharmacy technicians can aid in CPS support tasks on training, but it is unknown to what extent. Objective: To determine the effect of community pharmacy technicians on industry standard adherence performance measures after CPS training. Methods: Sixteen community pharmacy technicians within a supermarket chain division were chosen to participate in CPS training based on internal pharmacy benchmarking data. The training program consisted of 3 components: (1) classroom and (2) web-based training for medication therapy management platforms and (3) Hands-on in-pharmacy training. Researchers used pharmacy-specific EQuIPP reports of the proportion of days covered (PDC) for adherence related to diabetes, cholesterol, and hypertension to measure the primary outcome. September through October 2015 represented baseline data. November 2015 through March 2016 represented intervention data. Descriptive and inferential statistics were utilized for this retrospective analysis. The University of Tennessee Institutional Review Board classified the study exempt from review. Results: Overall, 100% of Cholesterol PDC 4-Star sites improved to a 5-Star score and 56% of sites improved in the Diabetes PDC score. All sites maintained a 5-Star score for RASA PDC postintervention. An average increase of 2.36% was observed for Cholesterol PDC across all sites. Possible lag time between the intervention and score improvements may limit relatability of results. Conclusions: This is the first study to report a positive trend between technician involvement in CPS and improvement in industry standard adherence performance measures. Further research capturing a longer time frame may be beneficial.
{"title":"The Effect of Community Pharmacy Technicians on Industry Standard Adherence Performance Measures After Cognitive Pharmaceutical Services Training","authors":"Leanne Justis, Jeremy Crain, M. Marchetti, K. Hohmeier","doi":"10.1177/8755122516669379","DOIUrl":"https://doi.org/10.1177/8755122516669379","url":null,"abstract":"Background: Cognitive pharmaceutical services (CPS) provided by pharmacists can improve patient adherence and industry standard performance measures. Community pharmacy technicians can aid in CPS support tasks on training, but it is unknown to what extent. Objective: To determine the effect of community pharmacy technicians on industry standard adherence performance measures after CPS training. Methods: Sixteen community pharmacy technicians within a supermarket chain division were chosen to participate in CPS training based on internal pharmacy benchmarking data. The training program consisted of 3 components: (1) classroom and (2) web-based training for medication therapy management platforms and (3) Hands-on in-pharmacy training. Researchers used pharmacy-specific EQuIPP reports of the proportion of days covered (PDC) for adherence related to diabetes, cholesterol, and hypertension to measure the primary outcome. September through October 2015 represented baseline data. November 2015 through March 2016 represented intervention data. Descriptive and inferential statistics were utilized for this retrospective analysis. The University of Tennessee Institutional Review Board classified the study exempt from review. Results: Overall, 100% of Cholesterol PDC 4-Star sites improved to a 5-Star score and 56% of sites improved in the Diabetes PDC score. All sites maintained a 5-Star score for RASA PDC postintervention. An average increase of 2.36% was observed for Cholesterol PDC across all sites. Possible lag time between the intervention and score improvements may limit relatability of results. Conclusions: This is the first study to report a positive trend between technician involvement in CPS and improvement in industry standard adherence performance measures. Further research capturing a longer time frame may be beneficial.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"50 1","pages":"230 - 233"},"PeriodicalIF":1.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75092979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/8755122516663219
S. Erickson, Kayla Kornexl
Background: Little is known about the adequacy of screening for and treatment of hypertension for people with developmental disabilities (DD). Pharmacists may assist in identifying and treating this special patient population. Objective: To characterize and compare the screening, treatment, and control of blood pressure (BP) in patients with DD to patients without DD. Methods: This retrospective study identified adult patients of primary care practices within a large academic health system who had DD (DD group) and a comparator group without DD (GenMed group). Outcomes assessed included percentage of patients screened, mean BP, percentage of patients with controlled BP, and antihypertensive medications prescribed. Results: The DD (n = 183) and GenMed groups (n = 497) were nearly all screened for BP. Mean systolic BP was significantly lower in the DD group (119.9 ± 14.6 mm Hg vs 122.8 ± 15.4 mm Hg GenMed, P = .03), while diastolic BP was no different (P = .7). Stroke was documented significantly more often in the DD group (5.5% vs 1.4%, P = .005). Of patients with uncontrolled BP, the DD group had significantly higher systolic BP (155.8 ± 14.1 mm Hg vs 147.4 ± 9.5 mm Hg GenMed, P = .02). Hypertension was documented in 32% of DD group versus 38.5% of GenMed group, P = .15. Of this group, 88.1% of the DD group had controlled BP versus 78.0% of the GenMed group, P = .09. Antihypertensive prescribing was not different between the groups. Conclusion: DD group patients had similar outcomes for hypertension therapy compared to patients without DD. Those with uncontrolled BP in the DD group tended to have higher systolic BP. Significantly more DD patients had a history of stroke.
背景:对于发育障碍(DD)患者的高血压筛查和治疗的充分性知之甚少。药剂师可以协助识别和治疗这一特殊患者群体。目的:表征和比较DD患者与非DD患者的血压(BP)筛查、治疗和控制。方法:本回顾性研究确定了大型学术卫生系统中有DD的成年患者(DD组)和无DD的比较组(GenMed组)。评估的结果包括筛查患者的百分比、平均血压、血压控制患者的百分比和抗高血压药物处方。结果:DD组(n = 183)和GenMed组(n = 497)几乎全部筛查出BP。DD组的平均收缩压明显降低(119.9±14.6 mm Hg vs 122.8±15.4 mm Hg, P = 0.03)，而舒张压无差异(P = 0.7)。卒中在DD组的发生率明显更高(5.5% vs 1.4%， P = 0.005)。在血压未控制的患者中，DD组的收缩压明显升高(155.8±14.1 mm Hg vs 147.4±9.5 mm Hg, P = 0.02)。DD组高血压发生率为32%，GenMed组为38.5%，P = 0.15。在该组中，DD组88.1%的患者血压得到控制，而GenMed组78.0%，P = 0.09。两组间抗高血压处方无差异。结论:DD组患者与非DD组患者相比，高血压治疗的结果相似。DD组血压不受控制的患者倾向于有更高的收缩压。DD患者卒中史明显增加。
{"title":"Blood Pressure Screening, Control, and Treatment for Patients With Developmental Disabilities in General Medicine Practices","authors":"S. Erickson, Kayla Kornexl","doi":"10.1177/8755122516663219","DOIUrl":"https://doi.org/10.1177/8755122516663219","url":null,"abstract":"Background: Little is known about the adequacy of screening for and treatment of hypertension for people with developmental disabilities (DD). Pharmacists may assist in identifying and treating this special patient population. Objective: To characterize and compare the screening, treatment, and control of blood pressure (BP) in patients with DD to patients without DD. Methods: This retrospective study identified adult patients of primary care practices within a large academic health system who had DD (DD group) and a comparator group without DD (GenMed group). Outcomes assessed included percentage of patients screened, mean BP, percentage of patients with controlled BP, and antihypertensive medications prescribed. Results: The DD (n = 183) and GenMed groups (n = 497) were nearly all screened for BP. Mean systolic BP was significantly lower in the DD group (119.9 ± 14.6 mm Hg vs 122.8 ± 15.4 mm Hg GenMed, P = .03), while diastolic BP was no different (P = .7). Stroke was documented significantly more often in the DD group (5.5% vs 1.4%, P = .005). Of patients with uncontrolled BP, the DD group had significantly higher systolic BP (155.8 ± 14.1 mm Hg vs 147.4 ± 9.5 mm Hg GenMed, P = .02). Hypertension was documented in 32% of DD group versus 38.5% of GenMed group, P = .15. Of this group, 88.1% of the DD group had controlled BP versus 78.0% of the GenMed group, P = .09. Antihypertensive prescribing was not different between the groups. Conclusion: DD group patients had similar outcomes for hypertension therapy compared to patients without DD. Those with uncontrolled BP in the DD group tended to have higher systolic BP. Significantly more DD patients had a history of stroke.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"1 1","pages":"234 - 239"},"PeriodicalIF":1.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90066309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-03DOI: 10.1177/8755122516672693
Haley M. Phillippe, B. Wright, Kathryn E. Bowerman, Miranda Andrus
Background: Direct oral anticoagulants (DOACs) have become available recently as an alternative to warfarin in appropriate patients. Few studies have been conducted that evaluate pharmacist-managed services for the management of the DOACs. Objective: To review the appropriateness of DOAC therapy and warfarin therapy in adult patients in a university-affiliated outpatient clinic and the need for further monitoring of these agents. Methods: A retrospective chart review was conducted of patients receiving a DOAC or warfarin therapy. Indication, dose, duration, age, weight, adherence, drug interactions, bleeding risk/history, renal function, and hepatic function were evaluated for DOACs and warfarin. If prescribed warfarin, international normalized ratio readings were also obtained. The pharmacists made verbal recommendations to primary care prescribers regarding findings, and changes to therapy were reviewed and documented. Results: A total of 175 patient charts were reviewed (49% DOACs, 51% warfarin). Twenty-five percent of prescribed DOACs should have been avoided due to inappropriate indication or renal function. The majority of these were switched to warfarin after discussion with the primary care provider. Of patients prescribed DOACs, 22% had a history of poor adherence to therapy and half of these were switched to warfarin. An additional 24% of prescribed DOACs were inappropriate due to incorrect dosing, major drug interactions, and/or renal dosing; however, these medications could be appropriate if adjustments are made. Nineteen percent of patients on warfarin therapy would be a candidate for DOAC therapy. Conclusion: Although there were limitations to this analysis, the results demonstrate that additional intervention is needed to improve appropriate prescribing and monitoring of the DOACs. Pharmacists can meet this need by providing medication reviews of novel anticoagulants and educating physicians.
{"title":"Pharmacist Interventions Regarding the Appropriateness of Apixaban, Rivaroxaban, Dabigatran, and Warfarin in a University-Affiliated Outpatient Clinic","authors":"Haley M. Phillippe, B. Wright, Kathryn E. Bowerman, Miranda Andrus","doi":"10.1177/8755122516672693","DOIUrl":"https://doi.org/10.1177/8755122516672693","url":null,"abstract":"Background: Direct oral anticoagulants (DOACs) have become available recently as an alternative to warfarin in appropriate patients. Few studies have been conducted that evaluate pharmacist-managed services for the management of the DOACs. Objective: To review the appropriateness of DOAC therapy and warfarin therapy in adult patients in a university-affiliated outpatient clinic and the need for further monitoring of these agents. Methods: A retrospective chart review was conducted of patients receiving a DOAC or warfarin therapy. Indication, dose, duration, age, weight, adherence, drug interactions, bleeding risk/history, renal function, and hepatic function were evaluated for DOACs and warfarin. If prescribed warfarin, international normalized ratio readings were also obtained. The pharmacists made verbal recommendations to primary care prescribers regarding findings, and changes to therapy were reviewed and documented. Results: A total of 175 patient charts were reviewed (49% DOACs, 51% warfarin). Twenty-five percent of prescribed DOACs should have been avoided due to inappropriate indication or renal function. The majority of these were switched to warfarin after discussion with the primary care provider. Of patients prescribed DOACs, 22% had a history of poor adherence to therapy and half of these were switched to warfarin. An additional 24% of prescribed DOACs were inappropriate due to incorrect dosing, major drug interactions, and/or renal dosing; however, these medications could be appropriate if adjustments are made. Nineteen percent of patients on warfarin therapy would be a candidate for DOAC therapy. Conclusion: Although there were limitations to this analysis, the results demonstrate that additional intervention is needed to improve appropriate prescribing and monitoring of the DOACs. Pharmacists can meet this need by providing medication reviews of novel anticoagulants and educating physicians.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"40 1","pages":"245 - 252"},"PeriodicalIF":1.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81527800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-21DOI: 10.1177/8755122516670415
T. Steckler
Telepharmacy involves pharmacist provision of clinical services at a distance and often includes electronic health record integration, audio-video connections, and increased patient access to pharmaceutical care. With the rapid expansion of this field comes critical questions that need to be answered by forward-thinking people in the profession. These issues include centralized checking workflows, potential reductions in patient counseling, and increased technician independence and responsibilities. If these points can be addressed with the needs of patients at the forefront, telepharmacy is poised to significantly advance access to care.
{"title":"Telepharmacy","authors":"T. Steckler","doi":"10.1177/8755122516670415","DOIUrl":"https://doi.org/10.1177/8755122516670415","url":null,"abstract":"Telepharmacy involves pharmacist provision of clinical services at a distance and often includes electronic health record integration, audio-video connections, and increased patient access to pharmaceutical care. With the rapid expansion of this field comes critical questions that need to be answered by forward-thinking people in the profession. These issues include centralized checking workflows, potential reductions in patient counseling, and increased technician independence and responsibilities. If these points can be addressed with the needs of patients at the forefront, telepharmacy is poised to significantly advance access to care.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"139 1","pages":"227 - 229"},"PeriodicalIF":1.0,"publicationDate":"2016-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85588000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-02DOI: 10.1177/8755122516667128
J. Goldman, J. White
Objective: To review 2 new basal insulin analogs that have been approved in the United States for use in type 1 and type 2 diabetes—insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL. Data Sources: PubMed was searched using the terms “insulin glargine 300 units/mL,” “Gla-300,” “insulin degludec,” “IDeg,” “insulin degludec 200 units/mL,” and “insulin degludec 100 units/mL” for articles published between 1995 and May 2016. Study Selection and Data Extraction: Clinical trials, meta-analyses and subanalyses were identified; review articles were excluded. Relevant citations from identified articles were also reviewed. Data Synthesis: The new basal insulins, insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL, have improved pharmacokinetic and pharmacodynamic profiles compared to insulin glargine 100 units/mL. All demonstrate longer durations of action, beyond 24 hours, and less variability. These improved profiles translate into comparable A1C reductions and comparable, or improved, levels of hypoglycemia compared to insulin glargine 100 units/mL. Conclusions: These benefits may lead to improved glycemic control in a range of patients with type 1 and type 2 diabetes with true once-daily dosing.
{"title":"Advances in Basal Insulin Therapy","authors":"J. Goldman, J. White","doi":"10.1177/8755122516667128","DOIUrl":"https://doi.org/10.1177/8755122516667128","url":null,"abstract":"Objective: To review 2 new basal insulin analogs that have been approved in the United States for use in type 1 and type 2 diabetes—insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL. Data Sources: PubMed was searched using the terms “insulin glargine 300 units/mL,” “Gla-300,” “insulin degludec,” “IDeg,” “insulin degludec 200 units/mL,” and “insulin degludec 100 units/mL” for articles published between 1995 and May 2016. Study Selection and Data Extraction: Clinical trials, meta-analyses and subanalyses were identified; review articles were excluded. Relevant citations from identified articles were also reviewed. Data Synthesis: The new basal insulins, insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL, have improved pharmacokinetic and pharmacodynamic profiles compared to insulin glargine 100 units/mL. All demonstrate longer durations of action, beyond 24 hours, and less variability. These improved profiles translate into comparable A1C reductions and comparable, or improved, levels of hypoglycemia compared to insulin glargine 100 units/mL. Conclusions: These benefits may lead to improved glycemic control in a range of patients with type 1 and type 2 diabetes with true once-daily dosing.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"46 1","pages":"260 - 268"},"PeriodicalIF":1.0,"publicationDate":"2016-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90051547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-31DOI: 10.1177/8755122516667127
Alicia B. Forinash, Danielle Chamness, Abigail M. Yancey, J. Koerner, K. Mathews, Collin Miller, Judy Thompson, T. Myles
Background: Asthma complicates 4% to 8% of pregnancies. The impact of clinical pharmacists providing asthma management and education to obstetric patients is unknown. Objective: Evaluate the impact of and patient satisfaction with clinical pharmacy services on asthma in pregnancy. Methods: This prospective quasi-experimental study enrolled 30 pregnant patients with asthma and assessed perceived asthma understanding, control, and inhaler technique before and after a clinical pharmacist visit and education. The primary outcome was change in pre- and postsurvey scores. Items were rated on a 5-point Likert-type scale; higher scores represented higher perceived knowledge or satisfaction. Secondary outcomes included inhaler technique scores, asthma control, correlating patient-specific factors with the primary outcome, and level of patient satisfaction with clinical pharmacy services. Results: Perceived knowledge of asthma in pregnancy median score (maximum score 50) significantly increased with clinical pharmacy education (37.5 pre vs 49 post, P = .001). Prior to clinical pharmacy services, patients highly rated their perceived knowledge of asthma in pregnancy with median scores on 7 of 10 items between 4 and 5. Despite this, significant changes were observed on 9 items. The proportion of patients with controlled asthma significantly increased after the pharmacist visit (33.3% vs 90%, P < .001). Satisfaction with clinical pharmacy services was overwhelmingly positive with average scores on all items 4.5 to 5. Inhaler technique scores significantly increased from baseline to follow-up (4 vs 7, P = .001). Conclusions: Pharmacists significantly improved patient perceived knowledge about asthma, asthma control, and inhaler technique. Patients were overwhelmingly satisfied with the care provided by the pharmacist.
背景:妊娠期哮喘并发症发生率为4%至8%。临床药师为产科患者提供哮喘管理和教育的影响尚不清楚。目的:评价临床药学服务对妊娠期哮喘的影响及患者满意度。方法:本前瞻性准实验研究纳入了30例妊娠哮喘患者，并在临床药师拜访和教育前后评估其对哮喘的认知、控制和吸入器技术。主要结果是调查前和调查后得分的变化。项目按照李克特5分量表进行评分;得分越高，表示认知知识或满意度越高。次要结局包括吸入器技术评分、哮喘控制、患者特异性因素与主要结局的相关性以及患者对临床药学服务的满意度。结果:临床药学教育显著提高妊娠期哮喘认知知识中位数(最高50分)(前37.5分vs后49分，P = .001)。在接受临床药学服务之前，患者对自己对妊娠期哮喘认知程度的评价较高，10个项目中有7个项目的中位数得分在4到5之间。尽管如此，在9个项目上观察到显著的变化。药师访视后哮喘得到控制的患者比例显著增加(33.3% vs 90%， P < 0.001)。对临床药学服务的满意度绝大多数是积极的，所有项目的平均得分为4.5至5分。吸入器技术评分从基线到随访显著增加(4比7,P = .001)。结论:药师显著提高了患者对哮喘、哮喘控制和吸入器技术的认知。病人对药剂师提供的治疗非常满意。
{"title":"Impact of Clinical Pharmacy on Asthma in Pregnancy in a Maternal-Fetal Care Clinic","authors":"Alicia B. Forinash, Danielle Chamness, Abigail M. Yancey, J. Koerner, K. Mathews, Collin Miller, Judy Thompson, T. Myles","doi":"10.1177/8755122516667127","DOIUrl":"https://doi.org/10.1177/8755122516667127","url":null,"abstract":"Background: Asthma complicates 4% to 8% of pregnancies. The impact of clinical pharmacists providing asthma management and education to obstetric patients is unknown. Objective: Evaluate the impact of and patient satisfaction with clinical pharmacy services on asthma in pregnancy. Methods: This prospective quasi-experimental study enrolled 30 pregnant patients with asthma and assessed perceived asthma understanding, control, and inhaler technique before and after a clinical pharmacist visit and education. The primary outcome was change in pre- and postsurvey scores. Items were rated on a 5-point Likert-type scale; higher scores represented higher perceived knowledge or satisfaction. Secondary outcomes included inhaler technique scores, asthma control, correlating patient-specific factors with the primary outcome, and level of patient satisfaction with clinical pharmacy services. Results: Perceived knowledge of asthma in pregnancy median score (maximum score 50) significantly increased with clinical pharmacy education (37.5 pre vs 49 post, P = .001). Prior to clinical pharmacy services, patients highly rated their perceived knowledge of asthma in pregnancy with median scores on 7 of 10 items between 4 and 5. Despite this, significant changes were observed on 9 items. The proportion of patients with controlled asthma significantly increased after the pharmacist visit (33.3% vs 90%, P < .001). Satisfaction with clinical pharmacy services was overwhelmingly positive with average scores on all items 4.5 to 5. Inhaler technique scores significantly increased from baseline to follow-up (4 vs 7, P = .001). Conclusions: Pharmacists significantly improved patient perceived knowledge about asthma, asthma control, and inhaler technique. Patients were overwhelmingly satisfied with the care provided by the pharmacist.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"32 1","pages":"240 - 244"},"PeriodicalIF":1.0,"publicationDate":"2016-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81420256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-28DOI: 10.1177/8755122516661736
C. White
Objective: Compare and contrast systematic reviews/meta-analyses assessing the time in the therapeutic range (TTR) for vitamin K antagonists (VKAs), clinical impact, and predictors. Data Sources: OVID MEDLINE search (1980-June 1, 2016) using the terms “vitamin K antagonist or warfarin” and “systematic review or meta-analysis” with backwards citation tracking from procured articles. Study Selection and Data Extraction: Search results were limited to systematic reviews assessing TTR with VKAs in patients with atrial fibrillation (AF) or venous thromboembolism (VTE). Data Synthesis: Six systematic reviews assessed TTR (4 in AF, 2 in VTE), and 3 of those assessed control at the time of a thrombotic or bleeding event (2 in AF, 1 in VTE). In patients on VKAs, greater TTR is correlated with fewer thromboembolic events and bleeding complications. VKA naïve patients have a harder time maintaining TTR than those with a previous knowledge of the likely therapeutic dose. Patients in the United States spend less TTR than those in other countries. Randomized clinical trials and anticoagulation clinics achieve greater TTR than those treated outside of these settings. The overall TTR has not improved from the first systematic reviews to the newest ones even though they were conducted 10 years apart and contained many new studies. Also, TTR in AF and VTE is similar. Conclusions: TTR is an important metric of VKA efficacy and safety and needs to be optimized. Many factors such as being VKA naïve can compromise TTR, and the use of anticoagulation clinics to optimize therapy is an important approach.
{"title":"INR Stability, Clinical Importance, and Predictors in Patients With Atrial Fibrillation and Venous Thromboembolism Receiving Vitamin K Antagonists","authors":"C. White","doi":"10.1177/8755122516661736","DOIUrl":"https://doi.org/10.1177/8755122516661736","url":null,"abstract":"Objective: Compare and contrast systematic reviews/meta-analyses assessing the time in the therapeutic range (TTR) for vitamin K antagonists (VKAs), clinical impact, and predictors. Data Sources: OVID MEDLINE search (1980-June 1, 2016) using the terms “vitamin K antagonist or warfarin” and “systematic review or meta-analysis” with backwards citation tracking from procured articles. Study Selection and Data Extraction: Search results were limited to systematic reviews assessing TTR with VKAs in patients with atrial fibrillation (AF) or venous thromboembolism (VTE). Data Synthesis: Six systematic reviews assessed TTR (4 in AF, 2 in VTE), and 3 of those assessed control at the time of a thrombotic or bleeding event (2 in AF, 1 in VTE). In patients on VKAs, greater TTR is correlated with fewer thromboembolic events and bleeding complications. VKA naïve patients have a harder time maintaining TTR than those with a previous knowledge of the likely therapeutic dose. Patients in the United States spend less TTR than those in other countries. Randomized clinical trials and anticoagulation clinics achieve greater TTR than those treated outside of these settings. The overall TTR has not improved from the first systematic reviews to the newest ones even though they were conducted 10 years apart and contained many new studies. Also, TTR in AF and VTE is similar. Conclusions: TTR is an important metric of VKA efficacy and safety and needs to be optimized. Many factors such as being VKA naïve can compromise TTR, and the use of anticoagulation clinics to optimize therapy is an important approach.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"92 1","pages":"253 - 259"},"PeriodicalIF":1.0,"publicationDate":"2016-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79999478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-12DOI: 10.1177/8755122516658767
Alicia B. Forinash, Danielle Chamness, Abigail M. Yancey, K. Mathews, Collin Miller, Judy Thompson, T. Myles
Objective: To evaluate physician satisfaction with clinical pharmacy services in an obstetrics teaching clinic. Study Design: A 35-question survey was created to evaluate demographics and provider satisfaction with clinical pharmacy services using 5-point Likert scale and open response questions. Surveys were administered to all clinic attendings, maternal fetal medicine fellows, and OB/Gyn residents in June 2014 via Survey Monkey. Results: Thirty-one physicians (83.8%) completed the survey. The first set of questions utilized a 5-point Likert-type scale ranging from “poor” (1) to “excellent” (5) and evaluated respondents’ impressions of the clinical pharmacists’ clinical knowledge and professional behavior. The median score was 5 (“excellent”) on all items in the survey, and many demonstrated an average response of 4.81 to 4.9 or higher, demonstrating that almost all respondents chose “excellent.” The next set of questions assessed the clinical pharmacist’s role with the clinic’s multidisciplinary team and asked respondents to answer questions based on a 5-point Likert-type scale ranging from “strongly disagree” (1) to “strongly agree” (5). The majority of responses to questions in this section were between 4.19 and 4.84. Reasons for referring patients to the clinical pharmacist were smoking cessation, asthma management, psych medication use/issues, adherence/polypharmacy, medication reconciliation, counseling on medication safety in pregnancy, insulin/heparin administration, and substance abuse. Conclusions: Overall, the survey identified a positive response and high level of physician satisfaction with clinical pharmacy services. Clinical pharmacy has the capacity to enhance pregnancy care and should be more routinely integrated into the prenatal care team.
{"title":"Physician Satisfaction With Clinical Pharmacist Services in an Obstetrics and Gynecology Teaching Clinic","authors":"Alicia B. Forinash, Danielle Chamness, Abigail M. Yancey, K. Mathews, Collin Miller, Judy Thompson, T. Myles","doi":"10.1177/8755122516658767","DOIUrl":"https://doi.org/10.1177/8755122516658767","url":null,"abstract":"Objective: To evaluate physician satisfaction with clinical pharmacy services in an obstetrics teaching clinic. Study Design: A 35-question survey was created to evaluate demographics and provider satisfaction with clinical pharmacy services using 5-point Likert scale and open response questions. Surveys were administered to all clinic attendings, maternal fetal medicine fellows, and OB/Gyn residents in June 2014 via Survey Monkey. Results: Thirty-one physicians (83.8%) completed the survey. The first set of questions utilized a 5-point Likert-type scale ranging from “poor” (1) to “excellent” (5) and evaluated respondents’ impressions of the clinical pharmacists’ clinical knowledge and professional behavior. The median score was 5 (“excellent”) on all items in the survey, and many demonstrated an average response of 4.81 to 4.9 or higher, demonstrating that almost all respondents chose “excellent.” The next set of questions assessed the clinical pharmacist’s role with the clinic’s multidisciplinary team and asked respondents to answer questions based on a 5-point Likert-type scale ranging from “strongly disagree” (1) to “strongly agree” (5). The majority of responses to questions in this section were between 4.19 and 4.84. Reasons for referring patients to the clinical pharmacist were smoking cessation, asthma management, psych medication use/issues, adherence/polypharmacy, medication reconciliation, counseling on medication safety in pregnancy, insulin/heparin administration, and substance abuse. Conclusions: Overall, the survey identified a positive response and high level of physician satisfaction with clinical pharmacy services. Clinical pharmacy has the capacity to enhance pregnancy care and should be more routinely integrated into the prenatal care team.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"19 1","pages":"191 - 195"},"PeriodicalIF":1.0,"publicationDate":"2016-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75017113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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