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IntroductionBased on the long-lasting diabetes management challenges in the United States, the objective was to examine glycemic levels among a nationally representative sample of people with diabetes stratified by prescribed antihyperglycemic treatment regimens and contextual factors.MethodsThis serial cross-sectional study used United States population-based data from the 2015 to March 2020 National Health and Nutrition Examination Surveys (NHANES). The study included non-pregnant adults (≥20 years old) with non-missing A1C and self-reported diabetes diagnosis from NHANES. Using A1C lab values, we dichotomized the outcome of glycemic levels into ResultsThe 2042 adults with diabetes had a mean age of 60.63 (SE = 0.50), 55.26% (95% CI = 51.39–59.09) were male, and 51.82% (95% CI = 47.11–56.51) met guideline-based glycemic levels. Contextual factors associated with meeting guideline-based glycemic levels included reporting an “excellent” versus “poor” diet (aOR = 4.21, 95% CI = 1.92–9.25) and having no family history of diabetes (aOR = 1.43, 95% CI = 1.03–1.98). Contextual factors associated with lower odds of meeting guideline-based glycemic levels included taking insulin (aOR = 0.16, 95% CI = 0.10–0.26), taking metformin (aOR = 0.66, 95% CI = 0.46–0.96), less frequent healthcare utilization [e.g., none vs. ≥4 times/year (aOR = 0.51, 95% CI = 0.27–0.96)], being uninsured (aOR = 0.51, 95% CI = 0.33–0.79), etc.DiscussionMeeting guideline-based glycemic levels was associated with medication use (taking vs. not taking respective antihyperglycemic medication classes) and contextual factors. The timely, population-based estimates can inform national efforts to optimize diabetes management.

Background: Despite US naloxone access laws, community pharmacists lack training and confidence in providing naloxone. Objective: To assess the impact of the Empowering Community Pharmacists program on pharmacists’ knowledge, perceived barriers, attitudes, confidence, and intentions regarding naloxone services implementation, as well as naloxone prescriptions dispensed. Methods: A 3-month pragmatic randomized controlled trial was conducted from December 2018 to March 2019. Alabama community pharmacists were recruited by mail, email, phone, and fax and randomized to intervention (monthly resources/reminders + educational webinar) or control (monthly reminders only). Outcome measures were assessed via online surveys at baseline (T1), immediately post-intervention (T2), and 3 months post-intervention (T3), including naloxone knowledge (%correct); perceived barriers, attitudes, confidence, and intention regarding naloxone services implementation (7-point Likert-type scale; 1 = strongly disagree, 7 = strongly agree); and number of naloxone prescriptions dispensed. Mean differences between control and intervention from T1 to T3 were assessed using 2-way mixed analysis of variance and adjusted analyses were conducted using generalized estimating equations with negative binomial distribution to assess associations between variables. Results: Of 55 participants (n = 27 intervention, n = 28 control), most were female (80.3%), white (80.6%), in independently owned pharmacies (39.1%). Increases in mean [SD] confidence (5.52 [1.03]-6.16 [0.74], P < 0.0005) and intention (5.35 [1.51]-6.10 [0.96], P = 0.023) occurred from pre- to post-program within the intervention group and were statistically significant compared with control (confidence P = 0.016, intention P = 0.014). Confidence (exp(β) = 1.46, P = 0.031) and perceived barriers (exp(β) = 0.75, P = 0.022) were associated with number of naloxone prescriptions dispensed. Conclusion and Relevance: The Empowering Community Pharmacists program improved community pharmacists’ confidence and intention regarding naloxone services implementation. Other states can adapt program elements according to their laws. ClinicalTrials.gov Identifier: NCT05093309

Introduction Current literature does not describe behaviors or the overarching opinion of pharmacy students on the use of different types of social media for personal and professional purposes. The objectives of this study were to identify predominant beliefs among pharmacy students regarding use of social media for professional and personal purposes, characterize pharmacy students' opinions on the effects of social media on their professional career, and determine pharmacy students' perceptions of using social media as tools for learning and discovery. Methods A self-administered questionnaire was administered to pharmacy students at Auburn University (N = 450) and Lipscomb University (N = 212). Linear regression was performed to predict students' perceptions of the importance of social media to their future professional life. Results The leading platforms commonly used by students for personal reasons were Facebook (92.5%), Instagram (70.5%), and Snapchat (70.5%). The most popular platforms used for professional reasons included LinkedIn (40.4%), Facebook (35.4%), and YouTube (29.2%). About 50% of respondents perceived social media to be important to their future professional life as pharmacists. Most students used YouTube and Wikipedia while studying or learning. The regression model predicting students' perceptions of the importance of social media to their future professional life was significant. Conclusions Pharmacy students most commonly use Facebook, Instagram, and Snapchat for personal reasons, and LinkedIn, Facebook, and YouTube for professional reasons. Educators may leverage YouTube and wikis to support the education of pharmacy students. Pharmacy students appear to be more aware and active with security settings than previously reported.

Immunization information systems (IISs) facilitate consolidated vaccination data within each state. Many have limited pharmacy participation, especially Alabama. As pharmacists increasingly engage in delivery of vaccines recommended across the life span, it is critical to understand the barriers to IIS implementation, particularly in rural community pharmacies where access to primary care may be limited.The purpose of this study was to identify barriers and facilitators to IIS implementation in rural, independent community pharmacies in Alabama.Qualitative interviews with rural, independent community pharmacy personnel and IIS experts in both states with high IIS participation and Alabama (state with low IIS participation) were conducted. States with high participation were identified as those with ≥75% of adults recorded in their respective state IIS. Less than 25% of Alabama adults were recorded in the state IIS at the time of this study. Deductive coding using CFIR constructs was conducted with a second coder to ensure inter-rater reliability. CFIR Rating Rules were applied to the coded data to allow for identification of constructs that have the greatest impact on implementation.A total of twenty-five participants (16 pharmacy personnel; 9 IIS experts) were interviewed. During interviews, 32 of 39 CFIR constructs were mentioned and 11 constructs with a strong influence (+2 or -2) were identified. These included, "adaptability", "complexity", "compatibility", "available resources", "access to knowledge and information", "needs and resources of those served by the organization", "peer pressure", "external policy and initiatives", "knowledge and beliefs about the innovation", "engaging key stakeholders", and "engaging innovation participants".This qualitative study explored perceived barriers and facilitators to IIS implementation in the rural, independent community pharmacy setting from the perspectives of pharmacy personnel and IIS experts. Factors identified can be used to inform the development of resources and implementation strategies to improve IIS uptake and participation.

Only 60% of adults nationwide and just 36.8% of adults in Alabama have immunization data recorded in an Immunization Information System (IIS). The objective of this study, which took place before the coronavirus disease 2019 (COVID-19) pandemic, was to evaluate the impact of an IIS training program on pharmacists' IIS enrollment, participation, awareness, knowledge, intention, and attitudes.A randomized controlled trial was conducted in 2019 among Alabama pharmacists (N = 41) practicing in independently owned pharmacies and providing vaccination services but whose pharmacy was not enrolled in Alabama's IIS (Immunization Patient Registry with Integrated Technology [ImmPRINT]). Intervention pharmacists were offered a 2-hour IIS training program, including an online continuing pharmacy education article, demonstration videos, implementation guide, and informational flyer. Control pharmacies received the informational flyer only. Pharmacy-level outcomes, including enrollment and participation, were obtained from ImmPRINT administrative records. Pharmacist-level outcomes, including awareness, knowledge, intention, and attitudes, were self-reported using baseline, 1-month, and 3-month surveys. Two-way mixed analysis of variance, chi-square, and independent t tests were used to analyze differences in outcomes between and within groups.Enrollment in ImmPRINT was significantly greater among intervention pharmacists' pharmacies (P = 0.035). In particular, 59.1% of intervention pharmacies compared with 26.3% of control pharmacies were enrolled in ImmPRINT at 3 months. No statistically significant differences were found between groups in terms of participation in ImmPRINT. Intervention pharmacists' awareness of IIS was significantly greater than control pharmacists (P = 0.028) at 1 month (postintervention). Furthermore, the IIS training program significantly improved intervention pharmacists' knowledge (P = 0.030) and attitudes (P = 0.016) toward IIS over 3 months compared with the control group.This pharmacist-centered training program focused on practical strategies to integrate IIS into pharmacy workflow. Results show that pharmacists' enrollment, awareness, knowledge, and attitudes significantly improved as a result of this training. As pharmacists become more involved in immunization efforts, particularly in response to COVID-19, awareness of and participation in responsible immunization documentation are critical.

OBJECTIVE To assess adolescents' preferred mobile app features and to propose a framework for evaluating health-related mobile apps for adolescents. METHODS PubMed, CINAHL, PsycINFO, ERIC, HealthIT.gov, and ClinicalTrials.gov were systematically searched in August 2017. Studies pertaining to app development, feasibility, or usability that reported preferred app features and rating criteria on mHealth (mobile health) apps intended for adolescents were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. Qualitative synthesis was performed to develop themes reflecting best practices for evaluating the quality of mHealth apps for adolescents. Using a grounded theory approach, we constructed a theoretical framework of rating criteria that can be used to inform development of an evaluation tool for mHealth apps targeted to adolescents. RESULTS Thirteen articles were included. Most commonly preferred features include ability to track test results or self-management progress, connect to social media, and gain points or prizes through app gamification. Common rating criteria include degree of app customizability, ease of use, visual appeal, and interactivity. Five emerging dimensions were used in the theoretical framework: Technical Quality; Engagement; Support System; Autonomy; and Safety, Privacy, and Trust. CONCLUSIONS We found that adolescents prefer mHealth apps that are customizable, offer peer support through social media, sustain engagement via gamification, and support the ability to visualize health trends via simplified graphs. Findings may help in the development of mHealth apps that are preferred by adolescents, as well as the development of a quality evaluation tool for mHealth apps targeted to this population.

Background: Adoption of healthcare technology in the ambulatory care setting is nearly universal. Clinical decision support system (CDSS)22 CDSS – clinical decision support system. technologies improve patient care through the identification of additional care opportunities. With the movement from paper-based to electronic clinical intake forms, the opportunity to improve identification of gaps in care utilizing CDSS in the ambulatory care setting exists. Objective: To evaluate the impact of CDSS-enhanced digital intake forms, with- and without aspects of gamification, on the identification of intervention opportunities in an ambulatory care pharmacy setting. Methods: Patients were invited to complete visit intake paperwork via virtual forms as part of a CDSS-enhanced mobile application designed to identify potential interventions based on patient age, sex, disease state(s), and user-provided information. Patients were randomized to receive optional patient-specific health questions 1) with or 2) without elements of gamification. Gamification elements included trivia questions, fun facts, and the chance to win a prize. A retrospective review was used to assess interventions identified for a random sample of patients seen within the same time frame who did not utilize the mobile application. Interventions were compared across groups utilizing ANOVA. t-tests were used for a subgroup analysis. Results: From January to May 2019, 353 potential interventions were identified for 220 study participants. 0.44 (±0.82), 1.8 (±2.0) and 2.1 (±1.8) interventions per participant were identified for the control, virtual forms, and virtual forms + gamification groups, respectively. Significant differences in intervention identification across groups were found using a one-way ANOVA (F = 17.46, p

Background As the number of providers administering vaccines increases, including pharmacists, there is a concern of fragmented immunization records in state and regional immunization information systems (IIS). In order for IIS to have complete records, it is critical that each provider administering vaccines, including pharmacists, participate and update the IIS each time a vaccine is administered to a patient. In Alabama, provider participation in the state IIS is not mandatory; as a result, less than 25% of adults over the age of 19 have immunization data recorded. IIS participation among independent pharmacies is of particular concern as approximately 40% of Alabama pharmacies are independently owned, but only 27% of these are enrolled in the IIS. Objective The objective of this report is to describe a study protocol to assess the impact of an IIS training program among community pharmacies’ IIS enrollment and actual participation rates. Methods The research design is a randomized controlled trial. Study participants are Alabama pharmacists who work in independently owned pharmacies that currently provide at least one type of non-seasonal vaccine and are not currently enrolled in the Alabama IIS. Multiple outcomes including awareness, knowledge, attitudes, intention, IIS enrollment, and IIS participation will be compared between intervention and control groups across three time points (baseline, one-month, and three-months). Individual and organizational factors will be measured to identify any possible associations with outcomes. Implications The expected outcome is to create an effective training program that is scalable and ready for dissemination. If successful, this training program can be replicated and used to significantly impact the completeness and accuracy of IIS across the U.S., providing the potential for IIS to be used consistently in assessing immunization status and recommending additional vaccines in the pharmacy setting, thereby improving vaccination coverage and making the provision of immunizations safe and efficient.

Background Asthma is an important public health issue in the United States. eHealth technology offers a potential solution to asthma treatment adherence, but the relative effect of various types of eHealth interventions has not been systematically studied. Objectives To systematically review the effectiveness of eHealth in improving adherence to inhaled corticosteroids (ICS) among patients with persistent asthma, as well as the satisfaction of patients undergoing eHealth interventions. Methods Literature searches were conducted in five databases in August 2018. Included studies were randomized controlled trials comparing eHealth interventions versus usual care in improving adherence among patients prescribed ICS for persistent asthma. Quantitative synthesis was performed using a random effects model. Results Eighty records were identified after removal of duplicates. Fifteen trials were eligible for qualitative synthesis. Included trials utilized: social media (n = 1), electronic health records (n = 1), telehealth (n = 6), and mHealth (n = 7). Twelve trials were eligible for quantitative synthesis. Results show a small but significant overall effect of eHealth interventions on adherence to ICS (Standardized Mean Difference (SMD) = 0.41, 95%CI = 0.02–0.79). Among the different types of eHealth interventions, a significant improvement in adherence was observed for mHealth interventions compared to usual care in a pooled analysis of 4 trials (SMD = 0.96, 95%CI = 0.28–1.64). However, there was considerable heterogeneity among studies. Patient satisfaction was evaluated in 5 trials comparing telehealth (n = 2) and mHealth (n = 3) with usual care. Participants found the interventions to be helpful and satisfactory. Conclusion eHealth interventions, especially mHealth interventions, are effective and acceptable in improving patient adherence to ICS.

Computerization is transforming health care while the quantity and complexity of biomedical knowledge rapidly grows. Today, all clinicians use health information technology (HIT), but only some pharmacists need to be cross-trained in "all" that advanced informatics entails so they can devise new and better information systems to support the pharmacy practice of the future. We propose a dual approach to informatics education in pharmacy: incorporate fundamental informatics education into pharmacy curricula for all students; and train some students interested in becoming informatics experts to design, develop, implement, and evaluate novel HIT for pharmacy. This commentary focuses specifically on the latter. It discusses the advanced pharmacy informatics training needed by some pharmacists to support innovation of HIT and to enable a shift to a more fully system-supported pharmacy practice.

The prescription drug abuse epidemic continues to grow. This multifaceted problem requires a multifaceted solution. In this installment, we discuss prescription drug monitoring programs and their relevance to hospital pharmacies.

We often find inspiration in tech happenings. This month, we explore the opportunities and challenges for using one of the most popular tech gifts of 2016 to advance safe and efficacious medication use.

In this column, we are making a short revisit to the technology that can assist in satisfaction of Meaningful Use criteria and can assist health systems that are increasing their population health initiatives to help improve outcomes while containing costs.

Learning never ceases. While continuing education is important for all of us, we are not speaking of licensure requirements. We are speaking of learning within your health system that systematically incorporates knowledge gained through research and clinical care into individual care.

Informatics is an increasingly important component of pharmacy practice. This domain, along with several technological modalities and services that underpin it, can facilitate the connection of the pharmacist to larger networks of information systems, healthcare providers, and health information technology (HIT). This, in turn, can help optimize all steps of the medication use process. In addition, digital health offers new roles and opportunities for pharmacy related to the leveraging of patient health-related data (e.g., medication adherence, behavioral, and wellness) over time. Informatics and digital health may also enhance patient-centered care within pharmacy and other allied health disciplines. Its inherently multidisciplinary nature also is suggestion of one route to enhance interprofessional education. Therefore, pharmacy educators and students should be familiar with the educational requirements and modalities associated with the integration of informatics and digital health in the goal of becoming practice-ready.

Objective To explore differences in perceived attributes of biometric screening services and organization characteristics among community pharmacies that adopt, outsource, or do not adopt biometric screening services that assess patients’ blood pressure, blood glucose, serum cholesterol, and body mass index. Design Qualitative, comparative analysis. Setting Independently owned community pharmacies in Alabama. Participants 25 key informants from community pharmacies were classified as adopters, outsourced adopters, and nonadopters of biometric screening services. Pharmacies using in-house staff to conduct screenings are referred to as adopters; those using external staff are referred to as outsourced adopters. Main outcome measures Perceived attributes of the screening service and organizational characteristics identified through emergent theme analysis based on the Diffusion of Innovations Model and Model of Innovation Assimilation. Results The screening service was perceived differently by adopters, outsourced adopters, and nonadopters. Adopters saw the opportunity to increase revenue and expand the role of the pharmacist in health care by offering the service. Adopters also perceived the service to be compatible with their pharmacy layout and organizational identity; simple to implement; modifiable in terms of experimentation with models of service delivery; and visible by external constituencies (which positively affects pharmacy image). In contrast, nonadopters felt the amount of time, investment, and lack of potential patients associated with the service influenced their decision not to adopt it. Adopters and nonadopters differed in regard to their innovativeness in patient care services, their connectedness in professional networks, and how they make sense of and deal with the uncertainty of new programs. Outsourced adopters were similar to adopters but were more cautious in their decision making. Conclusion Perceived attributes of the screening service and organizational characteristics differed among adopters, outsourced adopters, and nonadopters.

Background Observational data are useful for studying drug safety; however, to be effective, accurate outcome measurement is paramount. Objectives This study compared alternative outcome definitions for acute liver injury (ALI) and explored opportunities for improving ALI identification in observational data. Methods The Truven MarketScan® Lab Database (MSLR) was used to identify patients meeting at least 1 of 4 ALI definitions, including definitions based on diagnosis codes, laboratory measures, or combinations of diagnoses, procedures, and/or laboratory measures. Expert panelists reviewed patient data using a Web dashboard. Panelists determined whether they believed the patient had ALI and identified factors influencing their decision. Logistic regression models explored which factors were influential in case determination. Results Overall, only 37 of 208 reviewed patients (17.8%) were classified as cases. The diagnosis-based definition yielded no positive cases and the laboratory-based definition yielded the most positive cases (31 of 60). The most influential factors in case classification were occurrence of procedures after the index date (OR = 13.2, 95% CI = 5.3–32.9), no occurrence of drug treatments before the index date (OR = 4.6; 95% CI = 1.6–13.2), occurrence of drug treatments before the index date (OR = 0.3; 95% CI = 0.1–0.6), and no drug treatments after the index date (OR = 0.2; 95% CI = 0.0–0.5). Conclusions Comparing ALI definitions illustrated tradeoffs between the number of plausible cases identified and the likelihood of cases being classified as positive. Future research should refine ALI case definitions, considering the import of laboratory results, procedures, and drugs in defining a case.

This installment explores the domain of cognitive computing, using the well-known Watson as an example. The migration of computer manufacturers from a focus on hardware to a focus on services suggests the potential of these tools. Considerations for use of these tools in the health care system are provided.

Observational data can be useful for drug safety research, but accurate measurement of adverse health outcomes is paramount. Best practices for identifying important health outcomes of interest (HOI) are needed.To evaluate the extent to which health outcome definitions commonly used in observational database studies identify cases that are consistent with expert panel assessment of the underlying data.Competing HOI definitions were used to identify potential cases of acute liver injury (ALI; n = 208), acute kidney injury (AKI; n = 200), and myocardial infarction (MI; n = 204) in the Truven MarketScan Lab Database (MSLR). Panelists reviewed patient-level data and answered questions about whether they believed the case actually reflected the HOI and their certainty of case classification on a 10-point scale (1 = unlikely to 10 = likely). Each patient was reviewed independently by two panelists. Case disagreements were resolved through consensus meetings. Positive predictive value (PPV) was calculated as the number of cases deemed to be true over the total number of sampled cases. Kappa statistics assessed inter-rater agreement.PPV ranged from 0 to 52 % across ALI definitions, 12 to 82 % across AKI definitions, and 1 to 56 % across MI definitions. Certainty scores on the 10-point scale paralleled the PPV, with a range of mean values from 1.7 to 4.8 across ALI definitions, 3.1 to 6.0 across AKI definitions, and 2.8 to 5.7 across MI definitions. Inter-rater agreement was low to moderate (Kappa range 0.0-0.6).Existing HOI definitions had relatively low PPV based on expert panel review. Experts commonly disagreed on case classification. Additional work is needed to refine HOI case definitions if observational data are to be reliably used for health outcome assessment.

Mobile health (mHealth) can be defined as the use of mobile devices and global networks to deliver health services and information. Mobile devices most commonly include cell phones (i.e., feature phones and smartphones) and tablets (e.g., iPad, Surface). However, these devices can also come in the

BACKGROUND: Cardiovascular disease (CVD) is a major cause of mortality in the United States, representing the highest total expenditures among major diseases. To improve CVD-associated outcomes, medication therapy management (MTM) services have been included in essential health benefit packages offered by various health plans. Nevertheless, the impact of such MTM services on outcomes is still unclear, especially from the perspective of the self-insured employer. OBJECTIVES: To (a) compare economic outcomes between patients who received and those who did not receive MTM services from the self-insured employer’s perspective and (b) compare clinical outcomes before and after receiving MTM services. METHODS: This study consisted of 2 pre- and post-retrospective designs: (1) a cohort study with comparison groups and (2) a cohort study within group comparison. Patients were beneficiaries aged 19 years or older who were diagnosed with CVD conditions according to ICD-9-CM codes and continuously enrolled in a public university-sponsored insurance plan between 2008-2010. Patients were divided into MTM and non-MTM groups. The first MTM encounter was assigned as the index date for the MTM group. Match-paired patients who did not receive MTM services were randomly assigned the index date based on age category, gender, and comorbidity. Measures for pharmacy, medical, and total expenditures were obtained from medical and pharmacy claims. Paired t-tests and independent t-tests using data generated from 1000 bootstraps compared mean cost difference within and between groups. The return on investment (ROI) was calculated by dividing the average net benefit from MTM services by the average cost of MTM services. Clinical parameters, including blood pressure (BP) and body mass index (BMI), were retrieved from electronic medical records from a pharmacist-provided clinic where MTM services took place. Paired-t tests were used to compare the mean difference between baseline and endpoint values. Further, this study examined changes in the proportion of patients who achieved an individualized treatment goal for BP and BMI. The study also quantified the improvement in disease stages after the index date using the McNemar’s test. Statistical analyses were performed by using SAS software version 9.2 with statistical significance level of 0.05. RESULTS: A total of 63 patients and 62 match-paired patients were included in the MTM group and the non-MTM group, respectively. The mean cost (SD) per patient in the MTM group during the 6 months post-index period for CVD-related pharmacy, all-cause medical, and total expenditures was lower than the 6 months pre-index period by $22.0 (19.1), $79.2 (99.6), and $75.1 (136.2), respectively. In contrast, the mean cost (SD) for the nonMTM group increased during the 6 months post-index date by $10.7 (24.2), $246.4 (248.4), and $289.0 (269.5) for pharmacy, medical, and total R ESEAR C H expenditure, respectively. When comparing the 2 groups, the MTM group had statistically significantly lower costs per patient for pharmacy expenditures (difference of -31.9 ± 25.1, P < 0.0001), medical expenditures (difference of -$325.6 ± 271.2, P < 0.0001), and total direct expenditures (difference of -$359.3 ± 219.2, P < 0.0001). Given the net benefit of MTM services ($359.3) and the average cost of MTM service ($134.6), the ROI was $1.67 per $1 in MTM cost. Regarding clinical outcomes, while no statistically significant differences were observed in clinical outcomes, MTM services demonstrated clinical benefits. At the post-index period, the percentage of patients who had achieved their goals increased from 55% to 70% for BP and from 13.0% to 21.7% for normal BMI compared with the pre-index period. In terms of the extent of improvement in disease stages, clinical improvements in the stages of hypertension (χ 2 =12.77, P < 0.05) as well as BMI (χ 2 =6.39, P < 0.05) at the endpoint were observed. CONCLUSIONS: Cardiovascular-related pharmacy, all-cause medical, and total expenditures were statistically lower among beneficiaries who received MTM services compared with those who did not. In addition, MTM services had a positive ROI and demonstrated clinical significances by the increasing number of patients who achieved treatment goals and improved disease stages for hypertension and BMI. J Manag Care Pharm. 2013;19(5):385-95

Pharmacy administrators are often tasked with a range of responsibilities, from strategic planning and human resources to information systems management. Because of this, tools to support administrators' efficient and appropriate attention to everything on their plate can be valuable. Identification and evaluation of the available tools should be guided by careful consideration of the department's needs.

Take a little walk with us this month as we explore how things such as reimbursement systems are changing. Health systems are adopting population health strategies and performing experiments in rendering this type of care. Many health systems start with the care of their own employees, if they are self-insured. Perhaps you are already seeing this change and experiencing how your care is being impacted.

Objectives The star rating system implemented by Medicare has the potential to positively affect patient health and may have financial implications for community pharmacies. Learning from owners of community pharmacies with high performance on these quality measures may help us to identify and further understand factors contributing to their success. This study described high-performing community pharmacy owners' current awareness and knowledge of star ratings, attitudes toward star ratings and performance measurement, and initiatives being offered in pharmacies that aim to improve the quality of care. Methods Qualitative interviews with owners of independent community pharmacies were conducted in Spring 2015. Fifteen community pharmacies with high performance on the star rating measures were invited to participate. Recruitment did not end until the saturation point had been reached. All interviews were transcribed verbatim. Interview data were analyzed with the use of ATLAS.ti by 2 coders trained in thematic analysis. Krippendorf's alpha was calculated to assess intercoder reliability. Results Ten high-performing pharmacy owners participated. Analysis identified 8 themes, which were organized into the following categories: 1) current awareness and knowledge (i.e., superficial or advanced knowledge); 2) attitudes toward star ratings (positive perceptions, skeptical of performance rewards, and lack a feeling of control); and 3) pharmacy initiatives (personal patient relationships, collaborative employee relationships, and use of technology). Intercoder reliability was good overall. Conclusion Interviews with high-performing pharmacies suggested that awareness of the star rating measures, overall positive attitudes toward the star ratings, the relationships that pharmacy owners have with their patients and their employees, and the use of technology as a tool to enhance patient care may contribute to high performance on the star rating measures. Future research is needed to determine if and how these constructs are associated with pharmacy performance in a larger population.

Following another hospital stay, we have new observations on what it means to address patient needs. Some efforts are founded in technology, while others focus on the process of care. As a member of the broader care team, pharmacy should be aware of and engaged in institutional efforts focused on the patient experience.

Objectives To discuss opportunities and challenges for pharmacists' use of social media to affect health care. Data sources Not applicable. Summary Evolutions in social media (e.g., Facebook, Twitter, YouTube) are beginning to alter the way society communicates. These new applications promote openness, user-generated content, social networking, and collaboration. The technologies, along with patient behaviors and desires, are stimulating a move toward more open and transparent access to health information. Although social media applications can reach large audiences, they offer message-tailoring capabilities that can effectively target specific populations. Another powerful aspect of social media is that they facilitate the organization of people and distribution of content—two necessary components of public health services. Although implementing health interventions via social media poses challenges, several examples exist that display the potential for pharmacists to use social media in health initiatives. Conclusion Pharmacists have long played a role in educating patients on matters influencing health care. Social media offer several unique features that may be used to advance the role of pharmacy in health care initiatives. Public familiarity with social media, the economical nature of using social media, and the ability to disseminate information rapidly through social media make these new applications ideal for pharmacists wanting to provide innovative health care on both an individual and public level.

What constitutes a bonafide pharmacist–patient relationship? In the past, such a relationship required a series of face-to-face meetings between a patient and a pharmacist. The first change to this paradigm occurred with the development and acceptance of and eventual reimbursement for telepharmacy

The health information technology (IT) sector is experiencing dramatic growth and change. Today's pharmacist is presented with many options for keeping up with the latest health IT news. In this installment, we describe several of the resources we rely on to keep up-to-date, focusing on blogs. We believe that readers will ultimately use a mix of resources to keep up with the latest news.

The next US Census is quickly approaching. We have already seen a changing demographic in this country. The changes are more pronounced in some areas, while being less obvious in others. As the US demographics continue to change, how will this impact your institution's relationship with its patients? More important, how might language barriers impact your patients' care? These topics are addressed below.

We believe that, by now, even the pharmacists who try to avoid computers are at least vaguely aware of major changes in the ways the Internet has been used in the last 5 years. If you miss your favorite TV show, you can go to Hulu.com (or directly to the network Web site) to catch up. Arguing with your significant other about factual information is never necessary; as one of the de facto portals to accessing information, Google.com receives over 31 billion searches per month. Do not argue; just “Google” it. There are now more text messages being sent every day than there are people on the planet, and many are reporting that they spend more time online at home than they previously spent watching television. What does all of this mean for the health care profession?

Purpose. The literature describing pharmacists’ use of personal digital assistants (PDAs) as intervention documentation tools in health systems is reviewed. Methods. A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts to find articles whose title and abstract indicated that the articles’ content addressed pharmacists’ use of PDAs as intervention documentation tools. Qualitative analyses were conducted to characterize the existing literature on pharmacists’ use of PDAs to document interventions in health systems. The articles were categorized using eight characteristics: study type, objective, setting, participants, PDA platform, documentation software, results, and conclusions. Results. A total of 12 articles were included in this review. All articles were classified as descriptive. Two studies lacked objectives, while 10 contained explicitly stated objectives or objectives that could be inferred from article content. The majority of implementation processes occurred in acute care teaching facilities. All study participants were pharmacists. The majority of articles described PDA-based documentation by more than one pharmacist. Results from the articles can be divided into four categories: no measurable comparison performed, anecdotal comparison performed, survey data reported, and measurable comparison performed. Three articles specifically presented information regarding security and confidentiality of patient information. Each article described the use of password protection for the PDAs. Conclusion. The use of PDAs may increase the frequency and number of interventions documented by pharmacists; however, there is a lack of well-designed studies reporting the overall outcomes of using PDAs for intervention documentation by pharmacists.

Readers are living the reality of the government's efforts to move the United States health care system into an electronic environment. It is often easy to develop tunnel vision and focus on efforts at your home institution. In this column, we explore a big picture perspective using an online resource that provides national-level data focused on specific areas of interest.

It's been said that the best hospital stay is the one that doesn't occur. Certainly, Hospital Pharmacy's readers know that we are still working toward a completely safe health care delivery experience. In this installment, medication errors experienced during a hospital stay bring to light opportunities for health system pharmacies to create new points of engagement with their patients and increase patients' involvement in their care.

It may seem that our position is one of unwavering support for all things health information technology (HIT). However, we like to believe that we are cautious and deliberate in our evaluation of HIT. This month, we explore some of the common overt and covert challenges to optimal use of HIT.

Health systems can adopt the most advanced information systems and employ a facility full of progressive providers, but many of their efforts may fail if patients are not engaged. Blending the outputs of electronic health records in every transition, sharing and exchanging health information, and populating personal health records are among the technologies that are increasingly being used to bring patients inside the process and participating in the circle of care.

Purpose Results of the 2013 ASHP national survey on informatics are presented. Methods Pharmacy directors from all types and sizes of U.S. hospitals were included in the sample of 4893 individuals invited to participate in an online survey. The survey contained over 600 data elements that addressed the adoption and use of a variety of pharmacy informatics and technology. Data were analyzed by hospital type and size, accounting for sampling procedures and differences in response rate. Results Of the 4893 surveys distributed, 465 usable surveys were returned, yielding a response rate of 9.5%. Nearly 33% of hospitals reported having a complete electronic health record (EHR) (i.e., no paper charts). Adoption rates for computerized prescriber order entry, clinical decision support, electronic prescribing, and bar-code-assisted medication administration indicated that these technologies are clear priorities. Nearly half of respondents indicated using solely paper-based medication reconciliation processes, while almost as many reported using processes that combined electronic and paper methods. Overall, automated dispensing cabinets were more common in U.S. hospitals than were carousels and dispensing robots. The adoption of patient portals and personal health records is becoming common. Technologies identified as enablers of the Pharmacy Practice Model Initiative (PPMI) were found in at least 25% of hospitals. The average total number of pharmacy information technology full-time equivalents was 3.12. Conclusion This survey found widespread use of pharmacy informatics and technology across the entire medication-use process. Considerable progress was demonstrated in meeting meaningful-use measures for EHRs and meeting the recommendations of the ASHP PPMI.

Background Interdisciplinary practice is a primary focus within the United States health care system. Despite the existence of interdisciplinary educational efforts in pharmacy for many years, the practice only recently entered mainstream health care education. Informatics offers interdisciplinary educational opportunities. Mobile health (mHealth), an informatics sub-discipline, is the use of mobile devices for health and wellness activities. We used the mHealth domain as the context for an interdisciplinary learning experience for pharmacy and computer science and software engineering (CSSE) students. Educational activity Educational activities focused on creating an mHealth course sequence and an mHealth application (app). Students worked in teams to complete various assignments, including developing and presenting a course proposal, building a purchase plan for mHealth equipment, developing an mHealth app prototype, delivering a disease state presentation (pharmacy students only), developing use case scenarios (CSSE students only), and completing peer evaluations. Critical analysis of the educational activity Course evaluations were only available from pharmacy students. They indicated an overall favorable rating (mean 3.27–3.55; 4=strongly agree). Survey data collected after students entered the workforce indicated that students felt better prepared than their colleagues to work with individuals from other disciplines (mean 4.82; 5=strongly agree). Students also indicated using the knowledge from course proposal development in their careers (mean 4.27; 5=strongly agree). Through team interactions, students learned from each other while overcoming challenges related to terminology and content areas. Skills learned through team interactions reflect real-world processes and are expected to support students’ future professional responsibilities.

As a new year begins, we look ahead to several important topics that we will closely follow over the next 12 months. The list is certainly not exhaustive, but we believe these topics should be on all hospital pharmacy staff members’ radar screens.

Are the efforts of the nation's hospitals to implement electronic health records (EHRs) relevant to pharmacists? We believe they are. As we write another installment on the topic, we suggest that pharmacists have an important role in their institutions' efforts toward meaningful use of EHRs.

It is sometimes surprising to learn about the challenges patients face in maintaining health and wellness. Many of their challenges are things we may not commonly consider. Additionally, our preconceived ideas of what a patient experiences can often be off the mark. This month, we explore the segment of the population that is most commonly encountered in US hospitals.

One of our main objectives for this series is to identify methods to increase the efficiency of PDA use. As such, we support the PDA's current role as a tool for disseminating and gathering data. This month, we describe several ways to incease the ease and efficiency of entering data into a PDA.

Many of the articles in this series have been devoted to how the PDA can fit into the professional and personal lives of the pharmacist. We are convinced that the PDA is, and will continue to be, an invaluable resource for pharmacists and other health care professionals. However, as with any tool, you'll get the most out of your PDA if you know when and how to use it. This month, we discuss applications that can help you maximize the utility of your PDA.

There are ways to facilitate the successful implementation of technological innovations. These are especially important in a time of rapid development of new tools to support safe and effective medication therapy. This installment addresses some of the key components of a successful technology innovation strategy.

According to the Healthcare Information Management and Systems Society, “Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making” ( http://www.himss.org/library/clinical-business-intelligence ). Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

Hospitals and health systems are facing increased pressure to improve quality and outcomes while reducing expense. Quality-based reimbursement models are providing the necessary incentives for health care institutions to focus on issues such as avoidable hospital-acquired conditions and 30-day readmission rates. While our health care facilities certainly play a vital role in achieving optimal outcomes, patient engagement remains at the center of these efforts.