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PURPOSE: Current trends in medical school education indicate an existing need for increasing medical student exposure to pharmacotherapy education. The objectives of this study are to describe the development of an interprofessional, application-based Pharmacotherapeutics in Primary Care selective for 3rd year medical students and to assess its influence on knowledge, attitudes, and skills related to pharmacotherapy of high-risk medications and patient populations. METHODS: The selective was implemented across fourteen cohorts of medical students that were evaluated over a 5-year academic period (n = 68). Our curriculum was unique in that it merged basic pharmacology and pharmacotherapy concepts with application-based medication management of high-risk patients in addition to the incorporation of an interprofessional home visit experience. RESULTS: Pre- and post-assessment analyses found statistically significant improvements in students’ pharmacotherapeutic knowledge and skills. There was a significant increase in the knowledge post-test mean score (71.8; SD = 11.2) compared to the pre-test mean score (57.3; SD = 11.9; P

Introduction The primary objective of the study was to assess factors that predict pursuit of an oncology post-graduate year 2 (PGY-2) residency. Additional objectives included identifying the role of and exploring opportunities for PharmD curricula to increase student interest in the oncology field. Methods An anonymous 15-minute survey was developed and administered to oncology pharmacists and residents. Study participants were included if they were actively practicing as clinical pharmacists in an oncology setting in the US, maintained an active pharmacist license, and >18 years of age. Responses were analyzed using descriptive and inferential statistics. All results are reported in aggregate, with the exception of quotes obtained from open-ended responses. Results Eighty participants were included in analyses. After controlling for variance due to age, sex, race, years of practice, the number of oncology advanced pharmacy practice experiences (APPEs) correlated with pursuit of a PGY-2 residency in oncology (p = 0.047). Additionally, participants' perceived level of preparedness from didactic oncology training predicted pursuit of an oncology PGY-2 residency (p = 0.002). Emerging themes in pursuing oncology from open-ended items revealed that inclusion of supportive care in the didactic curriculum and having a family member or friend diagnosed with cancer were important factors. Additionally, participants' responses regarding PharmD curricula included recommendations to inform didactic and experiential education. Conclusions The results support the need for reevaluation of oncology education in PharmD curricula. Further studies could explore specific aspects of didactic curriculum that impact the level of student preparedness, and which elements encourage a student pharmacist to seek further training in the oncology field.

Purpose This quality improvement project aimed to assess the elements of the current workflow process that meets requirements for transitions of care from a family medicine inpatient to outpatient service following the Transitional Care Management (TCM) program developed by the Centers for Medicare & Medicaid Services. The purpose of the study was to assess the current family medicine workflow and determine whether the current process meets the criteria for billing and calculate the potential loss of reimbursement. Methods Interviews with key personnel, review of practice policies, and a retrospective chart review were performed for clinic patients discharged from the inpatient to outpatient family medicine service. Results A total of 37 patients met inclusion criteria for the chart review. Of these, 8% of patients seen at the outpatient clinic met all criteria for TCM. Potential reimbursement for those who met TCM criteria was $293.14 USD; the estimated potential TCM reimbursement for patients not meeting criteria was $1997.76 USD. Conclusion Standardized, team-based TCM services have shown to decrease readmission rates for high-risk patient populations. Results from this project identified processes in place at the family medicine practice to facilitate the development of a standardized transitional care service which could meet both TCM and best practice models.

Background: Past research has focused on understanding influenza vaccine acceptance in non-Hispanic white populations; however, research on the social causes of influenza vaccine acceptance rates in Hispanic populations is slowly developing. Objective: The purpose of this study was to assess theoretically driven predictors (i.e. attitudes, perceptions, behaviors, etc.) on influenza and the intention to vaccinate. Methods: A survey was administered to assess predictors of intentions to receive the influenza vaccine. The survey included items adapted from the National Flu Survey. Results: Key constructs common in models of health behaviors emerged as predictors of behavioral intentions to receive the flu vaccine. Recent vaccination within the past year ( P < 0.001), perceived effectiveness of the flu vaccine ( P < 0.004), and perceived safety of the flu vaccine ( P = 0.009) were predictors of intentions to vaccinate. Exploratory analyses revealed that government distrust was a statistically significant predictor of intentions to vaccinate ( P = 0.044). Conclusion: The above results have important implications for health-care providers and public health educators. The better we understand the relationship between theoretically driven predictors and vaccine behaviors, the more educators and health-care providers can focus on meaningful, culturally sensitive, targeted-vaccine education.

Objectives:: To determine the correlation between falls and two medication factors: the class of medications and potentially inappropriate medications (PIMs) prescribed to community-dwelling older adults aged 55 and older. Methods: Retrospective, cross-sectional study. Home health patients residing in a Texas/Mexico border community and reporting at least one fall within the past month. Medication use, medication classification, and potentially inappropriate medications (PIM) recorded by level of falls; non-fallers and recurrent fallers. Results: Of 99 participants, 13.1% reported falling once and 86.9% reported two or more falls. Participant’s average number of medications used was 10.51 (SD 5.75) with 93.9% having four or more prescribed medications. Average number of PIMs prescribed per participant was 1.42 (SD 1.51) with at least one PIM prescribed to 65.6% of participants. Twenty three out of 83 identified classes of prescribed medications met criteria for the study’s analyses but resulted in no significant association to falls when comparing NF to RF. Agents acting on the renin-angiotensin system and lipid modifying agents were the most frequently prescribed medication classes (N=55, 55.6%). Ibuprofen was the PIM most frequently prescribed (n=13, 13.1%). The correlation between use of a prescribed PIM and number of falls was not statistically significant (p=0.128). Conclusions: There was no correlation between classes of medication and level of falls. Recurrent fallers were more likely to have been prescribed a PIM than non-fallers (not significant). Although the analyses conducted for this study did not result in statistical significance, the high prevalence of polypharmacy and prescribed PIMs observed in these participants warrants a thorough review of medications to reduce fall risks among older adults.

Objectives Most national-level data regarding lesbian, gay, bisexual, transgender, queer/questioning, intersex, and allies (LGBTQIA) immunizations are limited. The primary objective of this study was to identify factors that influence behaviors, attitudes, and perceptions toward the uptake of the influenza vaccine within the Hispanic LGBTQIA community. Methods This was a prospective survey that assessed vaccine acceptability and practices regarding the influenza vaccine within the LGBTQIA community. Collection of data occurred through the use of social media platforms from July 2016 to May 2018. A total of 126 participants (mean age 32.03 ± 11.68 years) completed a 15-minute, 26-item, English/Spanish survey. A number of outcome measures assessed perceptions of vaccine effectiveness and safety. In addition, perceived severity of influenza symptoms and perceived susceptibility to contract influenza was assessed. Results A logistic regression model assessed the impact of several factors on influenza vaccine uptake. Perceived susceptibility of contracting influenza from the vaccine (P = 0.015) and perceived ease of receiving the influenza vaccine (P = 0.005) were the strongest predictors of vaccine uptake. Results showed no association between disclosure of sexual orientation and influenza immunization uptake (χ2 = 3.55; P = 0.17). Exploratory analyses revealed that non-Hispanic patients were more likely to perceive that their health care providers were aware of their sexual orientation compared with Hispanic patients (χ2 = 8.66; P = 0.013). Conclusion Several factors emerged as predictors of influenza vaccine uptake in the LGBTQIA population. Further studies are needed to explore additional factors such as disclosure of sexual orientation and variation of uptake based on vaccine type (STD vs. non-STD vaccines).

Falls are a leading cause of mortality among older adults worldwide. With the increasing aging population, falls are rapidly becoming a public health concern. Numerous internal and external factors have been associated with an older adult's increased risk of falling. Most notably visual impairments are gaining recognition for their critical role in fall events, particularly related to trips, slips and falls due to environmental hazards. This review presents the issue of vision and falls from a multidisciplinary health professional perspective. Discussions include the influence of visual impairment on mobility and activities of daily living, the effects of medications on vision, visual cognitive factors on falls risk and visual training interventions. Finally, implications for multidisciplinary health professional practice and suggestions for future research are offered.

Objective To evaluate the psychometric properties of a newly developed Medication Literacy Assessment in Spanish and English (MedLitR x SE). Design Descriptive, nonexperimental, cross-sectional study. Setting El Paso, TX, from December 2006 to June 2009. Participants 181 English- or Spanish speaking adults. Intervention Survey administered in two phases. Main outcome measures Descriptive statistics, internal consistency, confirmatory factor analysis (CFA) and fit indices, and criterion-related validity. Results The 20-item MedLitR x SE tool showed adequate internal consistency and reliability, and CFA revealed overall good model fit. In phase 2, the shorter 14-item MedLitR x SE showed good total test reliability and correlated well with the Short Test of Functional Health Literacy in Adults. Item response theory analyses showed no language bias and a one-dimensional (i.e., one factor) model of medication literacy. Conclusion The initial and latest shorter version of the MedLitR x SE tool demonstrated good psychometric properties. This tool may provide a new option to assess "medication literacy" in English and Spanish.

Objective To identify themes surrounding medication use practices and perceptions among individuals from a U.S.–Mexico border community recruited to participate in focus groups. Methods This study was conducted in El Paso, TX. Adult participants considered to be at risk for medication therapy problems (i.e., older adults, pregnant orbreast-feeding women, parents of young children) were recruited for participation. Focus groups and a survey were used to evaluate perceptions, concerns, and patterns of use of U.S. medications, Mexican medications, and herbal products. Results A sample of 73 adults, most of whom were Hispanicwomen (n = 60[82%]), were recruited for participation in seven focus groups. Across groups, the majority participated in the older adult cohort (n = 42[58%]), reported having an annual household income of less than $15,000 (n = 57[78%]), and identified that they had less than a high school education (n = 40[55%]). Four dominant themes emerged from the participants who completed both the survey and focus groups: (1) a "comfort" level for using a combination of U.S. medications, Mexican medications, and herbal products; (2) customary use of different drug information sources including physicians, Mexican pharmacy staff, U.S. pharmacists, and family members; (3) inconsistent levels of confidence in interpreting, measuring, and using medications; and (4) a sense of frustration regarding medication costs, which led participants to seek alternative options. Conclusion These qualitative results provide an increased understanding of medication use practices and perceptions in this population. Findings such as these can provide guidance and insight into the development of interventions to improve safe and effective medication use.

The use of multiple medications, herbs or nutritional supplements can lead to adverse consequences, particularly in the elderly. A significant consequence resulting from polypharmacy, polyherbacy and nutritional supplement use is the potential for interactions to occur among the various products. The primary objective of this study was to estimate the prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the US-Mexico border. This was a descriptive study that involved the administration of a bilingual (English/Spanish) questionnaire to a convenience sample of adults aged ≥60 years recruited from senior centres located within the most populated US-Mexico border region from June 2005 to March 2006. Participant demographics were collected in addition to information about current use of prescription medications, over-the-counter (OTC) medications, herbal products and nutritional supplements (i.e. nutraceuticals and vitamins or minerals). The outcomes measured were the number of prescription medications, OTC medications, herbal products, vitamins/minerals and nutraceuticals per participant. Furthermore, the number of potential interactions and major interactions between drugs, herbal products and nutritional supplements were identified for each participant. Additionally, product use patterns between men and women and among locations within the border region were compared. One-hundred-and-thirty participants (mean age 71.4 years) were recruited to complete the questionnaire. The prevalence of polypharmacy among all participants was 72.3% (n = 94), with 38.5% (n = 50) taking five or more concomitant medications (major polypharmacy). Twenty-one participants (16.2%) in the study sample reported taking two or more herbal products (polyherbacy). Thirty-four participants (26.2%) reported taking two or more vitamin/mineral supplements and nine (6.9%) reported using two or more nutraceuticals. Participants living on the US side of the border had higher rates of major polypharmacy, polyherbacy and use of nutritional supplements than those living on the Mexican side of the border. Overall, there were no significant differences in medication, herbal product and nutritional supplement use patterns between men and women. Evaluation of potential interactions revealed that 46.2% (n = 60) of participants were at risk of having at least one potential drug-drug interaction. Regarding drug and herbal product-supplement interactions, 31.5% (n = 41) of participants were at risk of having at least one possible interaction. The prevalence of polypharmacy among older adults living on the US side of the border was similar to national trends (estimates suggest that one-quarter to one-half of US adults aged ≥65 years take five or more medications). However, polypharmacy was less common in older adults living on the Mexican side of the border. Additionally, herb use was higher in older adults living on the US-Mexico border than has been reported in national surveys of US adults, which indicate that less than one-quarter of adults have used a herbal product within the previous 12 months. Furthermore, this study demonstrated that older adults living on the US side of the border consumed more herbs and nutritional supplements than their Mexican counterparts. In addition to describing product use patterns on the border, these findings suggest that almost half of the older adult participants were at risk for a potential drug-drug interaction, with approximately one-third having a potential interaction between their medications, herbs or nutritional supplements.