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*Objective: To evaluate the rate of allergy documentation during inpatient admissions and determine if discrepancies exist between ethnicities and English proficiency, genders, and by medication classes. Methods: Patients at an outpatient clinic with severe medication allergies documented in their electronic medical record were identified. Inpatient hospital admissions following the date this allergy was documented were reviewed and the presence or absence of this documentation in the inpatient electronic medical record was noted. An overall rate of successful documentation of allergies was calculated by dividing the number of admissions where the allergy was entered into by the total number of admissions where the opportunity to enter the allergy existed. Each patients ethnicity, gender, and the class of medication to which they were allergic to, was also recorded to determine if difference exist within each demographic. Results: Overall, allergy information was successfully entered in 84.6% of 246 hospital admissions. This rate was significantly lower (37.5%) among patients whose ethnicity groups, on average, have lower rates of English fluency. There was no significant difference between genders. Allergies to cephalosporins were less likely to be entered (44.4%). Conclusion: Patients who are not proficient in speaking English may be at an increased risk of experiencing an adverse drug reaction as their severe allergies are less likely to be documented during a hospital admission.

Objectives: This pilot study was designed to evaluate the impact of a pre-rotation workshop (PRW) on pharmacy students’ clinical skills and preparation for clinical Advanced Pharmacy Practice Experiences (APPE) involving direct patient care. Methods: Randomized controlled trial of an educational intervention with Institutional Review Board approval. PRW activities designed to simulate rotation activities around five competencies, patient charts, medication histories, SOAP notes, patient presentations, and professionalism. Endpoints were evaluated using clinical rotation preceptors’ evaluation of performance and students’ performance on objective structured clinical exams (OSCE). Results: Eight fourth-year students and eight GPA matched controls (20% of the total class) were selected to voluntarily participate. The PRW demonstrated a positive impact on students’ clinical skills and preparation for rotations by improving OSCE performance. However, no significant differences were found between groups when comparing preceptor evaluations of skills on rotations. These results are limited by the small sample size, potential OSCE "test-wiseness" effects, lack of OSCE evaluator blinding to study groups, potential case specificity effects due to the limited number of cases used on the OSCE and possible lack of sensitivity of the rotation evaluation tool to capture true differences among the experimental and control group participants. Conclusion: The PRW was successful at advancing students’ clinical skills and preparation for rotations and may be considered as a tool to help bridge didactic to clinical experiences in the Pharm.D. curriculum. Objetivos: Este estudio piloto se diseñó para evaluar el impacto de un taller pre-rotación (TPR) en las habilidades clínicas de los estudiantes de farmacia y en su preparación para las Practicas Clínicas Avanzadas de Farmacia (PAF) que envuelven atención directa al paciente. Métodos: Ensayo aleatorizado controlado de una intervención educativa con aprobación de la Junta de Revisión Institucional. Las actividades del TPR se diseñaron para simular las actividades de la rotación sobre 5 competencias: historias clínicas, historiales farmacoterapéuticos, notas SOAP, presentaciones de pacientes, y profesionalismo. Los resultados se evaluaron utilizando la evaluación de tutores de prácticas clínicas y exámenes clínicos estructurados objetivos (OSCE). Resultados: Se seleccionaron 8 estudiantes de cuarto año y 8 GPA controles emparejados (20% del total e la clase) para participar voluntariamente. El TPR demostró un impacto positivo en las habilidades clínicas de los estudiantes y en la preparación para sus rotaciones mejorando el desempeño en el OSCE. Sin embargo, no se encontraron diferencias significativas entre los grupos cuando se compararon las evaluaciones de los tutores de las habilidades en las rotaciones. Estos resultados están limitados por el pequeño tamaño de la muestra, posibles efectos de conocimiento de los exámenes OSCE, la falta de un evaluador OSCE ciego para los grupos de estudio, posibles especificidades de los casos debido al número limitado de casos usados en el OSCE, y posible falta de sensibilidad del instrumento de evaluación de la rotación para encontrar verdaderas diferencias entre los grupos control e intervención. Conclusión: El TPR tuvo éxito en aumentar las habilidades clínicas de los estudiantes y la preparación para la rotaciones, y podría considerarse una herramienta para reducir la brecha didáctica a la práctica clínica en el currículo de Doctor en Farmacia.

There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP) pharmacy. The Smith-Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p

Objective: This study describes Arkansas pharmacists’ knowledge, attitudes, and beliefs regarding emergency contraception. Methods: A cross-sectional survey was conducted among a convenience sample of pharmacists prior to a continuing education lecture. The 16-item survey included multiple choice and true/false questions to assess knowledge in addition to Likert-type scale questions regarding attitudes and beliefs. Frequency and descriptive statistics were calculated for all variables. Results: Eighty-eight pharmacists completed the survey. A majority (73%) knew that Plan B had been FDA-approved for nonprescription use yet 42% believed that it works by disrupting a newly implanted ovum. On a scale from 1-5 where 5=strongly agree, the mean item score was 3.2 for whether emergency contraception should be available for nonprescription use with counseling and 1.6 for nonprescription use without counseling. When asked what they would do if presented with a request for emergency contraception, 45.8% indicated they would dispense the drug, 22.9% would refer the patient to another pharmacist or pharmacy, 3.6% would refuse to dispense, and 27.7% were not sure. Almost half (48.6%) did not believe they were competent instructing patients on the use of emergency contraception. Conclusions: The results show that pharmacists could benefit from additional training on emergency contraception.

Atrial fibrillation affects an estimated 5 million Americans and accounts for approximately 15% of all strokes. Few studies have successfully addressed patient screening, assessment, and introduction of appropriate antithrombotic therapy in patients with atrial fibrillation. Objective: To assess whether an intervention improved planned antithrombotic prescribing at the time of discharge in hospitalized patients. Methods: The study was a prospectively designed, retrospectively evaluated, non-blinded, historical control study of a pharmacist-initiated intervention. The intervention, consisting of pharmacist review and assessment of antithrombotic prescribing in patients with non-valvular atrial fibrillation, was conducted in an urban teaching hospital. Results: Although antithrombotic prescribing was not significantly higher at discharge in the 252 enrolled subjects (control 67.3% vs. intervention 70.8%; p = 0.58), a significantly greater number of patients had a written discharge plan for antithrombotic therapy (control 73.5% vs. intervention 88.3%; p < 0.01). The adjusted odds ratio that the study group was associated with an improvement in planned or actual warfarin use was 2.46 (95% CI 1.63-3.74). In addition, clinicians adhered to guidelines for antithrombotic therapy in patients with atrial fibrillation more frequently in the intervention group (control 70.4% vs. intervention 88.2%; p < 0.01). Conclusion: A program designed to identify hospitalized patients with non-valvular atrial fibrillation, assess their need for stroke prophylaxis, and initiate appropriate antithrombotic therapy led to an increase in planned antithrombotic, and most importantly, warfarin use upon discharge from the hospital. Confirmation that an increase in planned antithrombotic use upon discharge results in an actual increase in use after discharge is needed to determine the true effectiveness of this intervention. La fibrilación auricular afecta aproximadamente a 5 millones de norteamericanos y aparece en el aproximadamente el 15% de todos los infartos. Pocos estudios han afrontado con éxito el cribado de pacientes, la evaluación y la introducción de tratamiento antitrombótico apropiado en pacientes con fibrilación auricular. Objetivo: Evaluar si una intervención mejoraba la prescripción antitrombótica planeada en el alta en pacientes hospitalizados. Métodos: El estudio fue diseñado prospectivamente y evaluado retrospectivamente, no ciego, con control histórico de una intervención iniciada por el farmacéutico. La intervención, que consistía en la revisión y evaluación por un farmacéutico de la prescripción antitrómbótica de pacientes con fibrilación auricular no valvular, se llevó a cabo en un hospital universitario urbano. Resultados: Aunque la prescripción antitrombótica no fuie significativamente mayor en el alta en los 252 individuos (control 67.3% vs. intervención 70.8%; p = 0.58), un número significativamente mayor de pacientes tuvo un plan escrito al alta para el tratamiento antitrombótico (control 73.5% vs. intervención 88.3%; p < 0.01). El odds ratio ajustado de que el grupo de estudio estaba asociado a un mejor uso de la warfarina planificada o real fue 2,46 (CI95% 1.63-3.74). Además, los clínicos se adhirieron a las guías de tratamiento antitrombótico en pacientes con fibrilación auricular más frecuentemente en el grupo intervención (control 70.4% vs. intervención 88.2%; p < 0.01). Conclusión: Un programa diseñado para identificar pacientes hospitalizados con fibrilación auricular, evaluar su necesidad de prevención de infarto e iniciar tratamiento antitrombótico llevó a un aumento de antitrombóticos planificados, y más importante, al uso de warfarina al alta del hospital. Se necesita la confirmación de que un aumento en los antitrombóticos planificados lleve a un aumento en el uso real para determinar la verdadera efectividad de esta intervención.

Objective: To identify patient factors associated with change in hemoglobin A1C (A1C) with adjunct pioglitazone therapy in routine clinical practice. Methods: This was a retrospective analysis of adult type 2 diabetes mellitus patients in a health maintenance organization setting who were newly-initiated on pioglitazone between January 2002 and December 2005. Eligible patients were receiving at least one other oral antihyperglycemic medication prior to initiating pioglitazone and maintained a stable dose of pioglitazone for 90 days. Data on eligible patients’ characteristics, pharmacy purchases, comorbidities, and A1C measurement 90 days prior to the pioglitazone purchase date (baseline) and 90 days after achieving a stable dose (follow-up) were obtained from electronic records. Multivariate regression modeling was used to assess factors independently associated with: 1) absolute change in A1C, 2) achieving a ≥1 percentage point decrease in A1C, and 3) achieving an A1C8%. At follow-up, the mean A1C change was -1.2 percentage points (interquartile range= -0.4, -2.1), 59% achieved a ≥1 unit decrease in A1C, and 44% achieved an A1C

Objectives To assess patients’ 1) satisfaction with their decision to enroll or not enroll in the Medicare Part D program, and 2) clinical status of diabetes before and after decision to enroll in Medicare Part D. Methods Patients 65 years or older were enrolled in the study from November 2006 through February 2007. Patients were screened by a clinical pharmacist at their clinician visit and administered a Medicare Part D satisfaction survey. Upon completion of the survey, a retrospective chart review was completed in diabetic patients who were enrolled in Medicare Part D to assess goal attainment of glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL) and blood pressure. Pre-enrollment values were obtained in the 6 months prior to the start of Medicare Part D enrollment (July 1- December 31, 2005). Post- enrollment values were obtained after enrollment was complete for the 2006 year (May 1- October 31, 2006). Results Results show that 74% (60/81) of patients surveyed were enrolled into the Medicare Part D program, including patients who have dual eligibility. Of the 60 patients who were enrolled in Medicare Part D, 48 patients (80.0%) responded that they were satisfied with their decision to enroll. Clinical outcomes were unchanged from the pre-enrollment to the post-enrollment periods. Mean HbA1c was 7.47% in the pre-enrollment period and 7.25% post- enrollment (differencepre-post = 0.23; 95%CI = -0.28 to 0.73). There was no change in LDL in the two time periods (pre = 79.4 mg/dL; post = 79.7; differencepre-post = -0.25; 95%CI = -13.6 to 13.1). Similarly, there were no significant differences observed for blood pressure. Mean systolic blood pressure was 129.5 in the pre-enrollment period and 131.6 in the post-enrollment period (differencepre-post = -2.1; 95%CI = -7.0 to 2.7). Mean diastolic blood pressure was 70.3 for the pre- enrollment period and 70.7 for the post-enrollment period (differencepre-post = -0.4; 95%CI = -4.2 to 3.4). Conclusion Patients were generally satisfied with their decision to enroll in Medicare Part D. Clinical outcomes were not affected by participation in a Medicare Part D plan. More longitudinal studies are necessary to determine long term impact of Medicare Part D on diabetes management.

The purpose of this one-year observational study was to evaluate quality of life in patients at the Medical University of South Carolina Family Medicine clinic who were followed by a clinical pharmacist diabetes educator. Methods: Patients who have been seen by the clinical pharmacist for diabetes education and management services were contacted by telephone and asked to complete a previously validated Diabetes-related Quality of Life (DRQL) survey. In addition, the patient's most recent hemoglobin A1C, blood pressure, fasting lipid panel and aspirin use were obtained from the electronic medical record. Correlation and logistic regression analysis was completed in order to assess the quality of life score and clinical outcomes. Results: A total of 47 patients completed the survey (37%). The median overall score was 1 (1-very satisfied; 5-very dissatisfied). Patients who were more satisfied with their current treatment tended to have lower LDL, systolic and diastolic blood pressure (BP) values (r=0.32, 0.3, 0.33; p=0.03, 0.03, 0.02). In addition, patients taking more medications were more dissatisfied with the amount of time spent managing their disease (r=0.29, p=0.04), felt more pain associated with the treatment of their disease (r=0.32, p=0.02), and were more worried that their body looked different as a result of their diabetes (r=0.32, p=0.02). Conclusion: Patients in this clinic were highly satisfied with their quality of life. The authors found that trends exist for relationships between several important clinical parameters and quality of life. El objetivo de este estudio observacional de un año fue evaluar la calidad de vida en pacientes en la clínica de medicina familiar de la Universidad de Carolina del Sur que eran seguidos por un farmacéutico clínico educador de diabetes. Métodos: Se contactó por teléfono a los pacientes que habían sido vistos por el farmacéutico clínico para su educación en diabetes y la gestión de servicios, y se les pidió que completasen un cuestionario previamente validado del Diabetes.related Quality of Life (DRQL). Además, se obtuvieron de la historia clínica los valores más recientes de hemoglobina A1C, presión arterial, perfil lipídico en ayunas y uso de aspirina. Se realizó un análisis de correlaciones y de regresión logística para evaluar la puntuación de calidad de vida y los resultados clínicos. Resultados: Un total de 47 pacientes completaron el estudio (37%). La mediana de la puntuación global fue de 1 (1-muy satisfecho; 5-muy insatisfecho). Los pacientes más satisfechos con su tratamiento actual tendían a tener menores valores de LDL, presión arterial sistólica y diastólica (r=0.32, 0.3, 0.33; p=0.03, 0.03, 0.02). Además, los pacientes que toman más medicamentos estaban más insatisfechos con el tiempo empleado en cuidar de su enfermedad (r=0.29, p=0.04), sentían más dolor asociado al tratamiento de su enfermedad (r=0.32, p=0.02), y estaban más preocupados de que su cuerpo pareciese diferente por causa de la diabetes (r=0.32, p=0.02). Conclusión: Los pacientes de esta clínica estaban altamente satisfechos con su calidad de vida. Los autores encontraron que existen tendencias de las relaciones entre varios parámetros clínicos importantes y la calidad de vida.

Objective: To compare the quantity of manuscripts published in journals by departments of pharmacy practice at schools and colleges of pharmacy in the United States for the years 2001-2003. Methods: We utilized the Web of Science bibliographic database to identify publication citations for the years 2001 to 2003 which were then evaluated in a number of different ways. Faculty were identified via American Association of Colleges of Pharmacy rosters for 2000-2001, 2001-2002, and 2002-2003 academic years. Results: Rankings were done based on the number of publications per institution and average number of publications per faculty member at an institution. Upon linear regression analysis, a relationship exists between an institution's faculty size and the total number of publications but not for tenure/nontenure-track faculty ratio. Rating highest in overall publication number did not guarantee high rankings in the average number of publications per faculty member at an institution assessment. Midwestern schools were responsible for more publications per institution than other regions. Many schools only generated minimal scholarship over this evaluative period. Conclusion: While many schools have pharmacy practice faculty that strongly contributed to the biomedical literature, other schools have not. Pharmacy practice faculty in the Midwest publish more journal manuscripts than faculty in other regions of the country. More pharmacy schools need to engage their faculty in scholarly endeavors by providing support and incentives. Objetivo: Comparar la cantidad de manuscritos publicados en revistas por departamentos de práctica farmacéutica (farmacia práctica) en las escuelas y facultades de farmacia en los Estados Unidos entre los años 2001-2003. Métodos: Utilizamos la base de datos bibliográfica de Web of Science para identificar las citas de publicaciones de los años 2001 a 2003 que fueron evaluadas de varias diferentes formas. Los académicos fueron identificados mediante los registros de la Asociación Americana de Facultades de Farmacia para los años académicos 2000-2001, 2001-2002, y 2002-2003. Resultados: Se realizaron ranking con el número de publicaciones por institución y la media de publicaciones por miembro académico de la institución. Mediante un análisis de regresión lineal, existe una relación entre el tamaño de una institución y el número total de publicaciones, pero no para el ratio de académicos titulares/no titulares. Puntuar en lo más alto del ranking de publicaciones totales no garantizó las puntuaciones en la evaluación del número de publicaciones por miembro académico en la institución. Las facultades del Medio-Oeste fueron responsables de más publicaciones por institución que las otras regiones. Muchas facultades solo generaron una mínima producción durante este periodo de evaluación. Conclusión: Mientras muchas facultades tienen académicos de farmacia práctica que contribuyen fuertemente a la literatura biomédica, otras facultades no. Los académicos de farmacia práctica del Medio-Oeste publicaron más manuscritos en revistas que los académicos de otras regiones del país. Más facultades de farmacia necesitan involucrar a sus académicos en acciones científicas proporcionando apoyo e incentivos.

Objectives: The purpose of this study was to gather longitudinal data on a pharmacy class cohort concerning programmatic components as well as develop a profile of student experiences as they progress through the curriculum.Methods: The Class of 2006 (n = 67) completed a 2 page instrument at the conclusion of the first 3 professional years (PY) concerning hours spent in various activities, overall quality of various programmatic components, relationships with others in the college, and employment information. During senior week, a more extensive exit survey was administered.Results: At the conclusion of PY1, 56.5% of the class was working as a pharmacy intern. By PY3 this increased to 88.1% with a decrease to 65.7% in the final year. The hourly range of hours worked followed the same pattern. The rating of Dean’s Office Staff and interactions with faculty members remained constant across all 4 years. In the final exit survey the 2 lowest rated program components were the quality of the interaction with assigned faculty advisor and the availability of professional electives. There was no difference across the professional years for the quality of relationships with staff or faculty; however, the mean rating of the quality of relationships with other students was higher for PY4 when compared to PY1.Conclusions: College faculty, administrators, and committees have used the information gathered from students in program assessment and enhancement efforts. Longitudinal data collection allows for tracking of changes and interventions.

The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug "load" between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some 177 patients resident for 30 or more days over a 19 month period of 2978 patient-months data were tabulated. A monthly repeated-measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. Results: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. Conclusion: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total "load" of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility. El propósito de este estudio fue determinar si había diferencias en las tasas de hospitalización debido a la carga de agentes psicoactivos en una residencia de ancianos entre los que utilizan psicotropos con los que no o los habían usado antes; determinar si el diagnóstico de demencia y el cambio en el uso y carga de medicamentos psicotrópicos y psicoactivos influye en las tasas de hospitalización. Métodos: Se realizó un estudio observacional de una cohorte retrospectiva de historiales de pacientes, cambios de situación en la residencia e informes del farmacéutico en una residencia de ancianos avanzada de más de 100 camas. Se tabularon datos de 177 residentes de 30 días o más durante un periodo de 19 meses, tabulándose un total de 2978 pacientes-mes. Se realizó un método de medidas repetidas de cambios de situaciones clínicas, enfermedades y medicación, para determinar la demografía, el uso de medicamentos y las hospitalizaciones de cada paciente. Resultados: Las tasas de hospitalización variaron de 0,04 a 0,07 por paciente/mes para el uso de cualquier psicoactivo en los que tenían o no diagnóstico de demencia. La tasa de hospitalización durante el periodo de estudio para los que no usaban actualmente psicotropos o psicoactivos fue de 0,02 y 0,03 por paciente/mes para los que tenían diagnóstico de demencia y los que no, respectivamente, aunque el 86% de esta muestra había usado psicotropos o psicoactivos antes del periodo de observación. Conclusión: Se ofrece evidencia preliminar que sugiere que los psicotropos y psicoactivos y la carga total de estos medicamentos puede estar asociada al aumento en la tasa y el riesgo de hospitalizaciones en una residenciad e ancianos avanzada.

Objective: To determine the prescribing patterns of family medicine residents for patients aged more than 60 years with 2 or more chronic diseases and seen at least twice in a 12 month timeframe. Methods: This is a descriptive analysis which was based on chart reviews. The setting was the University of Illinois-Rockford Family Practice Residency. Patients aged 60 years with 2 or more chronic diseases who were seen at least twice by second and third year residents. Results: Findings from this chart review include: 28.8% of the prescribed medications were not effective for the documented condition, 26.3% of the prescribed doses were incorrect, and 44.5% of the drugs prescribed were not the least expensive alternative. Discussion: This preliminary study suggests a need for a focused intervention with family medicine residents regarding inappropriate polypharmacy issues with older patients. Objetivo: Determinar los modelos de prescripción de los médicos de familia para pacientes de más de 60 años con 2 o más enfermedades crónicas y vistos al menos 2 veces en los últimos 12 meses. Métodos: Análisis descriptivo basado en revisión del os historiales. El emplazamiento fue la Residencia de Medicina de Familia de Rockford del a Universidad de Illinois. Los pacientes de más de 60 años con 2 o más enfermedades crónicas que fueron vistos al menos dos veces por los residentes de segundo y tercer año. Resultados: Los hallazgos de los historiales incluyen: 28,8% de medicamentos que no eran efectivos para la condición documentada, 26,3% de dosis prescritas eran incorrectas, y 44,5% de los medicamentos prescritos no eran más baratos que sus alternativas. Discusión: Este estudio preeliminar sugiere que es necesaria una intervención sobre los residentes de medicina de familia sobre los problemas de polimedicación inapropiada en ancianos.

Background: The adoption of clinical practice guideline recommendations for COPD is suboptimal. Determining the barriers to the implementation of these practice guidelines may help improve patient care. Objective: To determine whether barriers to the use of pharmacotherapy according to practice guidelines are related primarily to patient or prescriber factors. Methods: Retrospective cohort study. Members of a health maintenance organization identified as having spirometry-defined COPD ranging from stage II to IV. Electronic medical records were reviewed for documentation of the following: 1) patient affordability issues, 2) history of an adverse drug reaction, 3) history of inefficacy to therapy, and 4) prescription history. Results: A total of 111 medical records were reviewed. There were 51% of patients who had not filled medications that had been prescribed in accordance with guidelines and 43% did not have the guideline recommended medications prescribed in the previous year. Only 4% and 2% of patients had documented inefficacy and affordability issues, respectively. There were no reported cases of adverse drug reactions. Conclusions: This study provides insight to the acceptance of COPD treatment recommendations by patients and providers. Further research is needed to design interventions to reduce barriers and optimize COPD treatment. Antecedentes: La adopción de recomendaciones de las guías de práctica clínica es sub-optima. Determinar las barreras para la implantación de estas guías de práctica puede ayudara mejorar la atención al paciente. Objetivo: Determinar si las barreras para el uso de la farmacoterapia de acuerdo con las guías de práctica están fundamentalmente relacionadas con variables del paciente o del prescriptor. Métodos: Estudio de cohorte retrospectivo. Miembros de una organización de gestión de la salud identificados por tener EPOC definida por espirometría entre los estadios II a IV. Se revisaron los historiales médicos electrónicos para documentar lo siguiente: 1) capacidad económica del paciente, 2) historial de reacciones adversas, 3) historial de ineficacia del tratamiento, y 4) historial de prescripción. Resultados: Se revisó un total de 111 historiales médicos. Hubo un 51% de pacientes que no había completado la medicación que le habías ido prescrita de acuerdo con las guías y un 43% no había recibido las prescripciones recomendadas en las guías en el último año. Sólo un 4% y un 2% de pacientes había documentado problemas de ineficacia y de capacidad económica, respectivamente. No había registrados casos de reacciones adversas medicamentosas. Conclusiones: Este estudio proporciona una visión de la aceptación del as recomendaciones del tratamiento de EPOC por los pacientes y los proveedores. Se necesita un investigación para diseñar intervenciones que reduzcan las barreras y optimicen el tratamiento del a EPOC.

During patient care rounds with the medical team, pharmacy students have made positive contributions for the benefit of the patient. However, very little has been documented regarding the impact these future healthcare professionals are making while on clinical rotations. The objective of this study was to assess the impact that clinical interventions made by 6th year pharmacy students had on overall patient outcome. Using a special program for a personal digital assistant (PDA), the students daily recorded the pharmacotherapeutic interventions they made. The interventions ranged from dosage adjustments to providing drug information. Data was collected over a 12-week period from various hospitals and clinics in the Jacksonville, Florida area. In total, there were 89 pharmaceutical interventions performed and recorded by the students. Fifty interventions involved drug modification and fifty-four interventions were in regards to drug information and consulting. Of the drug information and consulting interventions, 15 were drug modification. This study shows the impact pharmacy students make in identifying, recommending, and documenting clinical pharmacotherapeutic interventions. Similar to pharmacists, pharmacy students can also have a positive contribution towards patient care. Durante las rondas de atención a pacientes con el equipo médico, los estudiantes de farmacia realizan contribuciones positivas en beneficio del paciente. Sin embargo, se ha documentado muy poco en relación al impacto de estos futuros profesionales de la salud en las rotaciones clínicas. El objetivo de este estudio fue evaluar el impacto que las intervenciones clínicas hechas por estudiantes de sexto año tenían sobre los resultados generales del paciente. Utilizando un programa especial para PDA, los estudiantes registraban diariamente las intervenciones farmacoterapéuticas que hacían. Las intervenciones iban desde ajustes de dosis a provisión de información de medicamentos. Los datos se recogieron durante 12 meses de varios hospitales y clínicas en el área de Jacksonville, Florida. En total, hubo 89 intervenciones farmacéuticas realizadas y registradas por los estudiantes. Cincuenta intervenciones involucraban modificación de medicamento y 54 intervenciones estaban relacionadas con la información de medicamentos y consultas. De estas informaciones de medicamentos y consultas, 15 fueron modificaciones de medicamentos. Este estudio muestra el impacto de los estudiantes de farmacia al identificar, recomendar y documentar intervenciones clínicas farmacoterapéuticas. Al igual que los farmacéuticos, los estudiantes de farmacia pueden tener una contribución positiva en la atención al paciente.

Thiazide diuretics are effective antihypertensive medications shown to reduce the risk of cardiovascular events and stroke. Despite being the preferred choice for uncomplicated essential hypertension, thiazide diuretics continue to be underutilized. Methods: Uncomplicated essential hypertension patients taking a single antihypertensive medication were evaluated upon enrollment, diagnosis after enrollment or initiation of therapy in treatment naïve patients. Clinician prescribing habits were determined for both pre-existing and newly diagnosed hypertensive patients. For the cost savings analysis, hydrochlorothiazide (HCTZ) 25mg daily was selected as the preferred conversion medication. Results: Four hundred seventy-eight patients were included. ACE inhibitors were the most prescribed at 35.4% (n=169), followed by dihydropyridine calcium channel blockers (DHP CCB) and thiazide diuretics, both at 20.3% (n=97). Only 12.9% (n=33) of patients with hypertension that were taking an antihypertensive medication upon enrollment were either continued or started on thiazide diuretic therapy. Newly diagnosed or treatment naïve patients were prescribed a thiazide diuretic 28.8% (n=64) of the time. DHP CCB accounted for 58.8% of the total medication cost per month with thiazide diuretics responsible for 0.8% of the cost. If all patients had been prescribed HCTZ 25mg daily, 95.8% of the total medication cost per month could have been saved. Conclusions: Thiazide diuretics were underutilized as preferred therapy in patients with pre-existing or newly diagnosed uncomplicated essential hypertension. While cost of therapy should not be the sole reason for medication selection, thiazide diuretics are an attractive option and should be considered as a preferred therapy in this patient population. Los diuréticos tiazídicos son medicamentos antihipertensivos que demostraron reducir el riesgo de eventos cardiovasculares e infartos. A pesar de ser la elección preferida para hipertensión arterial no complicada, los diuréticos tiazídicos continúan infrautilizados. Métodos: Se evaluó a pacientes con hipertensión esencial no complicada que tomaban un único antihipertensivo después del ingreso, diagnosticados en el ingreso, diagnostico después del inicio del tratamiento en pacientes nuevos. Se determinaron los hábitos de prescripción tanto para pacientes pre-existentes como para nuevos diagnósticos. Para el análisis de ahorros de costes, se seleccionó la hidroclorotiazida (HCTZ) 25mg como medicación de conversión preferida. Resultados: Se incluyó a 478 pacientes. Los IECA fueron los más prescritos con un 35,4% (n=169), seguidos de los bloqueantes de canales de calcio dihidropiridínicos (BCC DHP) y los diuréticos tiazídicos, ambos con un 20,3% (n=97). Sólo el 12,9% (n=33) de los hipertensos que estaban tomando antihipertensivos en el ingreso continuaban o habían iniciado con un diurético tiazídico. Se prescribió un diurético tiazídico a los nuevos diagnósticos o a los nuevos tratamientos sólo en el 28,8% (n=64) de las veces. Los BCC DHP sumaron el 58,8% del coste total por mes, siendo los diuréticos tiazídicos responsables del 0,8%. Si se hubiese prescrito HCTZ 25mg a todos los pacientes, se habría ahorrado el 95,8% del coste total de la medicación por mes. Conclusión: Los diuréticos tiazídicos estaban infrautilizados como tratamiento de elección en pacientes con hipertensión esencial no complicada de nuevo diagnóstico o pre-existentes. Auqnuei el coste no sea la única razón para las elección de la medicación, los diuréticos tiazídicos son una opción atractiva y deberían ser considerados como tratamiento de elección en este tipo de población.

Objective: This pilot, twelve-week, open-label study examined the effect of clozapine orally disintegrating tablet or ODT in patients with schizophrenia and schizoaffective disorder utilizing Positive and Negative Syndrome Scale (PANSS) as a long-term outcome measurement tool. Methods: The final study sample consisted of nineteen subjects who were residents a long-term care psychiatric facility in Pomona, California. Subjects were using clozapine ODT (FazaClo®) at the most clinically effective dosage depending on their symptoms and at the discretion of the psychiatrist and psychopharm consultant. PANSS were administered at baseline, week-4, week-8 and week-12. Paired sample t-tests were used to calculate the statistical significance of the mean differences for scores at baseline and week-12. Results: Mean differences from baseline indicated significant improvement on total score, as well as positive, negative, cognitive and general psychopathology subscales after twelve weeks of treatment. The greater average reduction in the negative syndrome subscale across the twelve weeks possibly illustrates the ability of clozapine ODT in improving negative symptoms, including cognitive function which is their ability to participate in their personal care and creative expressions in dance, arts, games, poetry to a greater extent their overall, quality of life and living along with the effect on positive symptoms. Conclusion: Overall, clozapine proved to affect a broad range of psychopathology including cognitive functions in this schizophrenic sample. Objetivo: Este estudio piloto de 12 semanas examinó el efecto de comprimidos oralmente dispersables (OD) de clozapina en pacientes con esquizofrenia o desordenes esquizo-afectivos utilizando la escala Positive and Negative Syndrome Scale (PANSS) como herramienta de medida de resultados. Métodos: La muestra final de estudio consistió en 19 individuos que residían en una clínica siquiátrica de larga estancia en Pomona, California. Los individuos estaban utilizando clozapina OD (FazaClo®) a la dosis más efectiva clínicamente dependiendo de sus síntomas y a discreción del psiquiatra y el consultor psicofarmacéutico. Se administró el PANS Sal inicio, en las emana 4, semana 8 y semana 12. Se utilizaron t-test apareados para calcular la significación estadística de las diferencias de las medias para las puntuaciones basales y en la semana 12. Resultados: Las diferencias medias del valor inicial indicaron mejora significativa en la puntuación total, así como en las subescalas positiva, negativa y de psicopatología general después de 12 semanas de tratamiento. La mayor media de reducción en la subescala negativa tras las 12 semanas posiblemente ilustra la capacidad de la clozapina OD para mejorar los síntomas negativos, incluyendo la función cognitiva que es la capacidad de participare n su cuidado personal y las expresiones creativa sen baile, arte, juegos, poesía y en mayor escalas u calidad de vida general ye l sobrellevar los efectos en los síntomas positivos. Conclusión: En general, la clozapina demostró afectar un amplio margen del a psicopatología, que incluye las funciones cognitiva sen esta muestra de esquizofrénicos.

Objective: Identify characteristics of Kentucky community pharmacists and community pharmacists´ practice environment associated with utilization of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER). Methods: Surveys were mailed to all 1,018 Kentucky pharmacists with a KASPER account and an additional 1,000 licensed pharmacists without an account. Bivariate analyses examined the association between KASPER utilization and practice type (independent or chain) and practice location (rural or urban). A multivariate Poisson regression model with robust error variance estimated risk ratios (RR) of KASPER utilization by characteristics of pharmacists´ practice environment. Results: Responses were received from 563 pharmacists (response rate 27.9%). Of these, 402 responses from community pharmacists were included in the analyses. A majority of responding pharmacists (84%) indicated they or someone in their pharmacy had requested a patient´s controlled substance history since KASPER´s inception. Bivariate results showed that pharmacists who practiced in independent pharmacies reported greater KASPER utilization (94%) than pharmacists in chain pharmacies (75%; p

*Background: Medication reconciliation in the outpatient setting is an important part of preventing medication errors, and is mandated by the Joint Commission. Objective: To describe and quantify medication reconciliation efforts by student pharmacists in an outpatient family medicine center. Methods: A retrospective review was conducted of medication reconciliation documentation forms completed by student pharmacists during an outpatient clinical rotation between May 2012 and April 2013. Discrepancies were defined as any lack of agreement between the medication list in the electronic medical record and the patient reported regimen. Descriptive statistics were used to report results. Results: A total of 557 medication reconciliation documentation forms from 12 student pharmacists were reviewed. The average number of medications per patient interviewed was 9 (range 0-25). A total of 1,783 medication discrepancies were found with an average of 3.2 discrepancies per patient. An additional 272 medication allergy discrepancies were identified. The most common discrepancy was medications the patient was no longer taking (37.3%, n=766). The second most common discrepancy was over-the-counter and herbal medications that had not been added to the medication list (16.2%, n=335). Patient counseling was documented 159 times during the medication reconciliation process. Conclusions: Medication reconciliation by student pharmacists in an outpatient family medicine center resulted in the identification of many discrepancies in medication lists in an electronic health record. Student pharmacists also documented and clarified medication allergies and performed patient counseling.

Background: Medication adherence is an integral aspect of disease state management for patients with chronic illnesses, including diabetes mellitus. It has been hypothesized that patients with diabetes who have poor medication adherence may have less knowledge of overall therapeutic goals and may be less likely to attain these goals. Objective: The purpose of this study was to assess self-reported medication adherence, knowledge of therapeutic goals (hemoglobin A1C [A1C], low density lipoprotein cholesterol [LDL-C] and blood pressure [BP]), and goal attainment in adult patients with diabetes. Methods: A survey was created to assess medication adherence, knowledge of therapeutic goals, and goal attainment for adult patients with diabetes followed at an internal medicine or a family medicine clinic. Surveys were self-administered prior to office visits. Additional data were collected from the electronic medical record. Statistical analysis was performed. Results: A total of 149 patients were enrolled. Knowledge of therapeutic goals was reported by 14%, 34%, and 18% of survived patients for LDL-C, BP, and A1C, respectively. Forty-six percent, 37%, and 40% of patients achieved LDL-C, BP, and A1C goals, respectively. Low prescribing of cholesterol-lowering medications was an interesting secondary finding; 36% of patients not at LDL-C goal had not been prescribed a medication targeted to lower cholesterol. Forty-eight percent of patients were medication non-adherent; most frequently reported reasons for non-adherence were forgot (34%) and too expensive (14%). Patients at A1C goal were more adherent than patients not at goal (p=0.025). Conclusion: The majority did not reach goals and were unknowledgeable of goals; however, most were provided prescriptions to treat these parameters. Goal parameters should be revisited often amongst multidisciplinary team members with frequent and open communications. Additionally, it is imperative that practitioners discuss the importance of medication adherence with every patient at every visit. Antecedentes: La adherencia al tratamiento es un aspecto integral de la gestión de la enfermedad para pacientes con enfermedades crónicas, como la diabetes mellitus. Se ha sugerido que los pacientes con diabetes que tienen baja adherencia a la medicación pueden tener peor conocimiento de los objetivos terapéuticos generales y puede ser menos probable que los alcancen. Objetivo: El propósito de este estudio fue evaluar la adherencia auto-comunicada a la medicación, el conocimiento de los objetivos terapéuticos (hemoglobina A1C [A1C], lipoproteinas de baja densidad [LDL-C] y presión arterial), y la consecución de objetivos en adultos con diabetes. Métodos: Se creó un cuestionario para evaluar la adherencia a la medicación, el conocimiento de objetivos terapéuticos, y la consecución de objetivos para adultos con diabetes seguidos en un departamento de medicina interna o de medicina de familia. Los cuestionarios se entregaron antes de la visita a la clínica. Se recogieron datos adicionales de las historias clínicas electrónicas. Se realizó un análisis estadístico. Resultados: Se incluyó un total de 140 pacientes. El conocimiento de los objetivos terapéuticos fue comunicado por el 14%, 34% y 18% de los pacientes encuestados para LDL-C, PA y A1C, respectivamente. El 46%, el 37% y el 40% de los pacientes alcanzó los objetivos de LDL-C, PA, y A1C, respectivamente. La baja prescripción de hipolipemiantes fue un hallazgo secundario interesante; el 36% de los pacientes no tenían prescrito un medicamento para bajar el colesterol. El 48% de los pacientes eran incumplidores; los motivos más frecuentemente comunicados para incumplir fueron el olvido (34%) y demasiado caro (14%). Los pacientes en el objetivo de A1C eran más cumplidores que los que no estaban en el objetivo (p=0,025). Conclusión: La mayoría no alcanza los objetivos y eran desconocedores de los objetivos; sin embargo, a la mayoría e les habían proporcionado medicamentos para tratar esos parámetros. Los parámetros objetivos deberían revisarse más a menudo entre los miembros del equipo multidisciplinario con comunicaciones abiertas y frecuentes. Además, es necesario que los facultativos discutan la importancia del cumplimiento de la medicación con capa paciente en cada visita.

Objective: To understand whether underserved populations attend to prescription warning label (PWL) instructions, examine the importance of PWL instructions to participants and describe the challenges associated with interpreting the information on PWLs.Methods: Adults from an underserved population (racial and ethnic minorities, individuals with low income, older adults) who had a history of prescription medication use and were able to understand English took part in semi-structured interviews. Participants were presented with eight different prescription bottles with an attached PWL. Participants were asked, “If this prescription was yours, what information would you need to know about the medicine?” The number of participants who attended to the warning labels was noted. Other questions assessed the importance of PWLs, the challenges with understanding PWLs, and ways a pharmacist could help participant understanding of the PWL.Results: There were 103 participants. The mean age was 50.25 years (SD=18.05). Majority attended to the PWL. Participants not currently taking medications and who had limited health literacy were likely to overlook the warning labels. Majority rated the warning instructions to be extremely important (n=86, 83.5 %), wanted the pharmacist to help them understand PWLs by counseling them on the information on the label (n=63, 61.2%), and thought the graphics made the label information easy to understand.Conclusions: PWLs are an important method of communicating medication information, as long as they are easily comprehensible to patients. In addition to placing PWLs on prescription bottles, health care providers need to counsel underserved populations on medication warnings, especially individuals with limited health literacy who are not currently using a prescription medication.

Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT) device versus venipuncture within ambulatory care clinics at our institution. Methods: All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC) Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED) visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis. Results: A total of 145 patients were included in the data collection from the two clinics. The majority (41%) of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 %) of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post- implementation of POCT device. Conclusion: The results of this study demonstrate improvement in patient satisfaction with POCT compared to venipuncture, with limited value in clinical outcomes.