• Evaluating Health and Adherence Outcomes of Medication Therapy Management Calls in Rural Health

      Bertsch, Matthew; Hatchard, Jared; Coombe, Courtney; Darian, Nicole; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: To determine whether medication therapy management (MTM) calls have an impact on previously non-adherent patients. To describe the various interventions pharmacists may make to improve medication therapy regiment. Subjects: Adult, English-speaking patients taking chronic medications with an adherence rate of <80% at Sun Life Family Health Center in Casa Grande, Arizona. Methods: A pretest-posttest design was used to determine the importance of MTM calls on adherence. Pre and Post MPR scores were evaluated using paired t-test. Data on prescription pick up success rates, reasons for poor adherence, and type of intervention was also collected. Main Results: MTM calls were made to 149 patients, of which 74 of them were reached. Of the patients reached, 78% of them picked up their medications. MPR scores increased in all patients by 3.11% (p = 0.0034; 95% CI, -5.19 to -1.04) and patients reached increased by 5.63% (p = 0.0035; 95% CI, -9.37 to -1.89). Conclusions: Pharmacist intern driven MTM calls make a statistically significant impact in improving adherence scores for maintenance medications.
    • Safety and Efficiency of Workflow Automation in Medication Tray Verification

      Hodges, Zachary; Catt, Kord; Rallison, Gabriel; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: The purpose of this study was to determine the impact of using barcode assisted automation in the medication tray verification process on efficiency and error rates. Methods: The time required to prepare a medication tray was initially recorded. This was followed by a secondary employee reviewing the tray and recording medication errors in the tray. Following the implementation of the automation system, the time for each tray preparation was logged by the system and trays were randomly audited for errors via convenience sampling. Main Results: Automation produced an elimination of all observed errors, which can be quantified as an estimated mean reduction of 6.86 errors per day (95 percent CI, 6.53 to 7.19 errors, p-value of 0.00017). Additionally, efficiency in tray preparation improved with a mean reduction of 38.5 seconds per tray (p-value of 0.0003). Conclusions: Automation proved to improve both safety and efficiency during the tray verification process. The number of errors found in the trays were reduced significantly after the implementation of the barcode assisted automation system.
    • Heparin-Induced Thrombocytopenia Alert Analysis

      Buckley, Mitchell; Spence, Nathan; Barrett, Brandy; Ciambella, Michelle; Uraine, Makenna; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: To evaluate the various parameters for triggering a heparin-induced thrombocytopenia (HIT) alert including platelet count, duration of heparin therapy from start date to when alert triggered, and percent drop in platelet count from baseline, and to review how those affect the positive predictive value. Subjects: Patients across all Banner Health facilities from January 2016 to December 2018 who had a HIT alert triggered during their stay. Methods: Positive predictive value (PPV) was calculated for 84 different logic rule combinations of platelet count, duration of heparin therapy to alert trigger, and percent drop in platelet count from baseline. A chi squared analysis of each individual criterion was then performed in order to select a logic rule that maximized the PPV and minimized the HIT alerts populated. Main Results: Using a logic rule of absolute platelet count of 150,000 or less, percent decrease of 50% or greater, and any duration would provide a PPV of 11.8% and 1,383 less alerts compared to Banner's current logic rule. Conclusions: Changing Banner's logic rule to absolute platelet count of 150,000 or less, percent decrease of 50% or greater, and any duration may be beneficial as it results in fewer total alerts triggered while also increasing the PPV.
    • Influenza Acquisition occurring Post-Vaccination Among University of Arizona College of Pharmacy Students

      Tram, Kim; Slack, Marion; Marlott, Megan; Flynn, Shannon; Patel, Payai; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims Assess the incidence of influenza despite being vaccinated among pharmacy students in the 2017/2018 influenza season at the University of Arizona. Our working hypothesis is that pharmacy students who received the influenza vaccine in the 2017 year will have a lower rate of acquisition than among people who did not receive the influenza vaccine. Methods Questionnaires were administered to first, second, and third year pharmacy students during scheduled class times to gather information on influenza acquisition, influenza symptoms, vaccine attainment, and demographic characteristics through self-reported answers. Main Results The characteristics of pharmacy students were similar between those who acquired the flu or not. However, whether or not the pharmacy students had kids was significantly different between those who had influenza versus not ( p= 0.0146) Pharmacy students who received the vaccine had lower rates of acquiring the flu compared to the national average (p=0.0005). When comparing pharmacy students who received the vaccine and those who did not there was no difference in acquiring influenza (p= 0.854) Conclusions The findings for this study show that pharmacy students who received the influenza vaccine had lower rates of acquiring the flu when compared to the national average of people who were not vaccinated and acquired the flu. It can be assumed that even with an efficacy as low as 40%, the vaccine still plays a great role in influenza prevention. However, pharmacy students who received the influenza vaccine in the 2017 year did not have significantly different acquisition rates of the flu when compared to the students who did not receive the influenza vaccine that year.
    • Association of PCOA scores; GPA; and other factors with NAPLEX Pass Rate: A cross sectional retrospective evaluation at one College of Pharmacy

      Warholak, Terri; Yambert, Joel; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: To identify certain variables as predictors for overall NAPLEX passing scores for this University of Arizona College of Pharmacy Class of 2018 cohort. By the end of the study, associations between GPA, PCOA scores, and other factors should lead to a predictive tool for accessing a student's future success (or failure) on the NAPLEX. Methods: Data was collected via University of Arizona College of Pharmacy admissions data along with release of MPJE and NAPLEX scores as well. The data was compiled together without demographic data to ensure anonymity of each participants' records. Main Results: Stepwise logistic regression showed that the PCOA scaled score was a predictor for NAPLEX outcome, estimated parameter value: -0.0457 (p=0.0015). There was a significant difference in the pre-admissions cumulative GPA between the group passing the NAPLEX (mean GPA=3.61, SD=0.28) and the group that did not pass (mean GPA=3.30, SD=0.15) using a t-test statistic (p <.0001). The differences between PCOA (p <.0001) and composite PCAT scores (p=0.0286) also differed significantly between those who passed and those who failed the NAPLEX. Moderate, statistically significant correlations were found between NAPLEX scaled score with MPJE scaled score (r=0.59, p <.0001) and PCOA scaled score (r=0.51, p <.0001). Conclusions: The PCOA test and pre-admissions GPA are good potential predictors for determining a student's outcome (pass or fail) on the NAPLEX test.
    • Prevalence of Depressive and Anxiety Symptoms Among Pharmacy Students: Evidence to Support the Need for Optimizing Delivery of Mental Health Resources at a Pharmacy School

      Warholak, Terri; Vadiei, Nina; Shangraw, Ann; Silvers, Jacob; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: To assess the prevalence of significant anxiety and depressive symptoms among first-, second-, and third-year pharmacy students. To compare the number of students with anxiety and depressive symptoms as the spring semester progressed per class year. To compare the overall mean anxiety and depressive symptoms across time. To identify student self-reported barriers to using mental health resources. Methods: This was a repeated-measures, mixed methods study which included surveys and focus groups. Surveys were administered in February and April during mandatory courses for first-, second-, and third-year pharmacy students. Surveys included the: 7-item Generalized Anxiety Disorder (GAD-7); 9-item Patient Health Questionnaire (PHQ-9); and demographic questions. Symptoms were compared per class year using a Chi-square test. Conglomerate mean scores were compared based on time using a t-test. Focus groups were held on each campus of the university. Responses were categorized by barrier type mentioned. Main Results: For surveys, 30% of students self-reported significant anxiety symptoms and 22% of students self-reported significant depressive symptoms. More second-year pharmacy students selfreported anxiety and depressive symptoms as the semester progressed (p < 0.005 and p < 0.001 respectively). Depressive symptoms were significantly higher later in the semester (April vs. February) for all students (p = 0.021). The largest reported barrier for using mental health resources differed by campus. Conclusions: About 1 in 4 students self-reported symptoms of anxiety and depression. More secondyear pharmacy students reported anxiety and depressive symptoms later in the semester. Overall, the overall mean depressive score increased as the semester progressed.
    • Red Cap Implementation on Schedule II Prescription Opioids in Arizona

      Oh, Seung; Ho, Jennifer; Ho, Victoria; Kwak, Bona; Nguyen, Bethany; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims Specific aim #1: Assess patients' knowledge of schedule II prescription opioids and awareness of opioid epidemic. Specific Aim #2: Identify demographic factors are associated with red cap intervention. Methods This prospective, observational study used data obtained through questionnaires with patients who were recruited at two Fry's community pharmacies (store numbers 611 and 115) in Mesa, Arizona. Total of 205 completed questionnaire forms were collected and patients categorized into those who recognize the red cap implementation on schedule II prescription opioid versus those who did not recognize the change of implementation. Patients who were answered questionnaires correctly 6 or more out of 11 questions were considered more knowledgeable and aware of opioid in this study. Chi-square test was used to evaluate statistical significance (P value less than 0.05). Main Result Statistical analysis by Chi Square test detected a significant difference in knowledge, awareness level, age, ethnicity, gender and occupation in patients who recognized the change of red caps on schedule II prescription opioids versus those who did not (P equals 0.03). Conclusion Patients who recognized the implementation of red caps on schedule II prescription opioids are associated with more knowledge and increased awareness regarding opioids and its adverse effects. Also, those who are younger than 50 years of age, Caucasian, female, and work in healthcare-related fields are found to be more knowledgeable and aware of opioid use compared to the other group.
    • Risk factors for radiologically confirmed VTE in hospitalized pediatric patientsless than 1 year of age

      Slack, Marion; Kurz, Rhonda; Evans, Nate; Shumway, Cody; Webb, Aaron; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims Healthcare providers at Phoenix Children's Hospital (PCH) perceived an increase in rates of venous thromboembolism (VTE) in neonates and infants. This study aimed to identify the rate of VTE at PCH and compare to other pediatric institutions. Secondarily this study aimed to identify risk factors for VTE for all patients with central venous catheters at PCH. Methods An IRB approved retrospective chart review including inpatients < 1 year of age who underwent CVC placement or developed VTE was conducted. Patient demographics, characteristics of CVC, and known co-morbidities and risk variables were collected along with rates of VTE for infants < 1 year of age Pediatric Health Information System (PHIS) database for comparison. A Chi2 Test was used for comparison of VTE rates and multivariate logistic regression for risk factors/ characteristics of CVC analysis. Main Results The VTE rate was found to be 1.3257 per 1000 patient days, which was higher than 37 of 52 centers. In 100% of VTE cases a CVC was present. Presence of congenital heart disease(CHD) was found in 56% of cases with a significantly increased risk of VTE (OR=2.718, 95% CI: 1.12-6.52). Analysis of the size of CVC related to VTE demonstrated CVCs ? 4 French were associated with an increased frequency of VTE compared to CVCs ? 3 French (OR=19.2, 95% CI: 2.1-3.8). Conclusions The rate of VTE for this patient population warrants further attention and venous diameter measurements need to be performed and documented.
    • Potential Impact of a Smartphone Lifestyle App Intervention on Therapeutic Decisions in the Prevention and Treatment of Metabolic Disease in the VA Healthcare System

      Zerr, Beth; Dimitrova, Nina; Spence, Alexis; Maghari, Saba; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: To identify clinical decision parameters required to gain support on the implementation of a lifestyle intervention app from the perspective of multiple types of providers. To determine if a there are groups of providers more likely to use the lifestyle modification app based upon metabolic markers seen in current BeWell24 App. To identify barriers to implementation of the lifestyle app in the VA PACT model. Methods: Questionnaires administered via secured encryption email as well as physical paper handouts distributed at PACT team huddles and meetings or individually arranged times. Providers rated the importance of the following parameters on their therapeutic decisions: change in hemoglobin A1C, fasting blood glucose, waist circumference, blood pressure, triglycerides, and HDL as well as answer qualitative questions on the practical implementation of the BeWell24 Lifestyle App. Main Results: The subjects were current Phoenix VA employees including physicians, pharmacists, nurse practitioners, physician assistants and nutritionists. Providers expected reductions as follows: A1c 0.5-0.9%, 20-29 mg/dL Fasting Blood Glucose, weight 12-15 kg, systolic blood pressure 7-10 mmHg and Triglycerides11-15%. Each discipline had similar expectations of what improvements patients should show intervention, no statistical significance between groups (p = 0.993). Providers identified barriers to implementation including time and technology on both the patient and provider use. Conclusions: VA providers of various types had similar expectations on the BeWell24 app as it relates to patient reduction in metabolic risk factors and were able to provide valuable feedback to implementation of the lifestyle intervention into the VA system.
    • Acute Adverse Effects of Cannabis: A Perspective from Arizona’s Poison Control Centers: Addendum

      Dudley, Steven; Heydorn, Christian; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims This is an addendum to Acute Adverse Effects of Cannabis: A Perspective from Arizona's Poison Control Centers. * The original purpose was to examine and describe some of the acute adverse effects of cannabis that have been reported in the state of Arizona in order to provide insights into potentially pertinent toxicities. Another aim was to examine the data for any correlation between age and side effects experienced. The addendum to this study will provide more data to examine while using the same methods. Also, a secondary set of information will be analyzed. It will include if the type/route of cannabis used correlates with the number of side effects. Methods De-identified data tables detailing case information for cannabis-related calls made to either of the two poison control centers in the state of Arizona in the years 2017-2019 were prepared and analyzed. Data examined included age, gender, and general descriptors of the side effects reported for each patient case. A chi-square was utilized to look for any association between age group and the different types of adverse effects reported. For the secondary set of data, a chi-square was utilized to look for any association between types of cannabis use and the different types of adverse effects reported. Main Results A total of 555 poison control center cases were examined. Side effects involving the central nervous system, cardiac systems, and mental health were among the most commonly reported. There was a correlation found between age and the occurrence of any particular type of adverse effect (p < 0.005). Also, there was a correlation found between type of cannabis used and the occurrence of any of the same categorical type of adverse effect (p <0.005). Conclusions This addendum concluded differently from conclusion of AAEC, which concluded that there was no correlation between age groups and side effects. With the additional data included, this project found a correlation. Lack of data was a limitation in AAEC. This addendum was able to show that there was a correlation between age and side effects. The secondary analysis also showed that there was a correlation between type/route of cannabis used and the number of side effects.
    • An Interventional study to assess knowledge and perception of strategies to minimize burnout among PharmD students

      Lee, Jeannie; Chang, John; Robles, Gregorio; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Methods Presentation and Questionnaire administered during college hour collected burnout levels and knowledge base from 2nd year pharmacy students. Main Results A total of 42 second year pharmacy students completed the burnout questionnaire (20 men and 22 women). The data was stratified based on demographic characteristics. There was no statistically significant difference in the burnout scores by age, gender, marital status, having children or type of job they hold. Knowledge based questions showed that students are more aware of burnout and ways to alleviate burnout after attending the burnout management presentation (All P-value < 0.03). Using the modified Maslach Burnout Inventory for students, about 30% of students reported experiencing burnout once a month or less, while 52% of students reported a few times a month and 12% expressed experiencing burnout once a week. Therefore, at least 64% of students were feeling burnt-out a few times a month or more, in the second year of the PharmD program. Conclusion Burnout is evident in second-year pharmacy students at the University of Arizona College of Pharmacy with the majority of participants reporting multiple burnout incidences a month. A student-developed and delivered educational intervention on awareness of burnout management was found to improve participants' knowledge of burnout awareness and ways to alleviate burnout.
    • Anti-Aging Effects of Rapamycin; Resveratrol; and Topical Melatonin on the Skin

      Campbell, Ashley; Bondugji, Dena; Nguyen, Thao; Hegazy, Somaya; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: The specific aim of this study is to explore the effects of topical melatonin, resveratrol, and rapamycin on slowing the progression of and reversing skin aging symptoms. Methods: A comprehensive search strategy using keywords for 'topical melatonin,' 'resveratrol,' 'rapamycin,' and 'skin aging' was developed. Articles were identified through a systematic search of bibliographic databases. Interventional and observational studies in humans or human skin cells were included if at least one group received one of the active ingredients of focus, and at least one outcome related to skin anti-aging was reported. Three investigators worked through disagreements on inclusion eligibility through discussion and consensus generation and bias assessment was performed. Main Results: There were a total of 17 studies that met inclusion criteria. Overall, the studies involving topical melatonin and resveratrol, positive outcomes included skin wrinkle reduction, increased skin hydration, improved skin tonicity or complexion, and reduction in hyperpigmentation, or age spots. Outcomes of the one article on rapamycin that met inclusion criteria included an increase in dermal thickness, diameter, and density of collagen fibers. Conclusions: Available studies identified through this systematic review suggest that resveratrol and topical melatonin appear to be modestly effective at reducing the appearance of aged skin. While a body of literature exists that examines rapamycin on a molecular level, more human studies must be carried out in order to gain a better understanding of its potential benefits on skin aging.
    • A Descriptive Study Identifying Pharmacist Workforce Gaps in Arizona

      Cameron, Caitlin; Fazel, Maryam T.; Fossati, Eliane; Nguyen, Tiffany; Raslan, Gamal; Bermingham, Trevor; Cameron, Caitlin; Alamer, Ahmad; Fossati, Eliane; Raslan, Gamal; et al. (The University of Arizona., 2020)
      Purpose. To determine if there are specific in demand knowledge/skills in pharmacy profession that applicants do not meet. Methods. Arizona licensed Pharmacists as of 5/14/2019, were invited to participate in an optional/anonymous descriptive electronic questionnaire to be completed using QualtricsXM. The survey contained eight domains assessing various knowledge/skills expected from pharmacist applicants. Descriptive statistics were used for respondents' characteristics, Chi-square test for categorical data, multivariate logistic regression to identify respondents' characteristics influencing their responses, and qualitative thematic analysis technique to assess the free responses. Results. Out of 7570 invited pharmacists, 970 responded (response rate=12.8%). In analyses, 686 respondents (88% working, 48.1% with precepting experience, 55.7% involved with hiring) included. Majority worked in chain community pharmacies (32.6%) followed by inpatient setting (21.6%). About 50.1% found pharmacist applicants able to effectively dispense medications and 46.4% able to provide appropriate therapeutic recommendations. Conversely, 42% stated that applicants lacked conflict management skills. Multivariate logistic regression showed respondents involved in hiring were more likely to find applicants lacking management skills, conflict management and laws/regulation knowledge than those not involved in hiring (ORadj=0.51 [95% CI (0.31-0.83), p<0.01], ORadj=0.49 [95% CI (0.29-0.80), p<0.01], ORadj=0.48 [95% CI (0.22-0.99), p=0.05] respectively). Qualitative thematic analysis found 37% of respondents finding applicants deficient in professionalism/work ethic, 34% in patient communication, and 24.2% in management skills. Conclusion. Our findings suggest gaps in management and conflict management skills, professionalism/work ethic, and patient communication in pharmacy workforce in Arizona. Interventions to bridge these gaps should include curricular and real-life trainings in these areas.
    • Prevention of memory decline in older adults with mild cognitive impairment using leisure activities: A systematic review

      Lee, Jeannie; Slack, Marion; Wei,Dylan; Pham, Thu; Goldberg, Alicia; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: Mild cognitive impairment (MCI) is a serious problem facing the elderly population today that can result in not just decreased memory, but physical injuries such as tripping due to movement difficulties. Due to this growing problem, it is the aim of this systematic review to look at cognitive stimulating leisure activities and their effects on MCI and overall memory. Methods: Using Appendix B studies were first screened to check if they fit the inclusion criteria of the systematic review. Following the screening, any study that fit the inclusion criteria and did not possess any exclusion criteria was then read again using Appendix C to extract the needed data from the studies to compare against each other. Main Results: Candidate studies included had individuals ?65 years old, diagnosed with MCI without Alzheimer’s or serious dementia, participated in studies that included cognitively stimulating activities measured by standardized memory tests. Tai Chi was the most studied intervention, showing significant improvement in executive function with the Trails Making B-A test (p<0.02). A study using dance also showed that there was better memory recall within their group compared to standard care (p=0.011). Conclusions: Subjects with MCI that participated in cognitively stimulating activities overall had a greater improvement in their memory than control groups. 7 out of the 9 studies resulted in statistically significant results in favor of the intervention groups, and of the other 2 studies, 1 demonstrated significant improvement, however it did not meet the minimum detectable change value.
    • Self-reported NAPLEX pass rates and educational factors among University of Arizona College of Pharmacy graduates from 2017-2019

      Warholak, Terri; Kay, Jarred; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Background: Over the past few years, the North American Pharmacist Licensure Examination (NAPLEX) has seen a decrease in national pass rates. This has become a concern for both pharmacy colleges as well as recent Doctor of Pharmacy (PharmD) graduates. The purpose of this research project is to identify factors that correlate to NAPLEX pass rates among PharmD graduates at the University of Arizona. Methods: Recent alumni from the University of Arizona's PharmD program were provided with a survey that asked a variety of questions regarding the NAPLEX as well the PharmD curriculum. This data was analyzed to assess for any correlations or trends that may present areas of improvement in the PharmD curriculum. Results: From the self-reported NAPLEX scores obtained, there have been no statistically significant changes in NAPLEX scores over the past 3 years. In recent years, students in the PharmD program at the University of Arizona have felt less prepared to take the NAPLEX. There was no statistically significant correlation between self-reported PCOA scores and NAPLEX. A significant majority of alumni felt that their participation in paid internships helped prepared them for the NAPLEX in ways that the PharmD curriculum did not. Conclusions: Due to the limited accessibility and abundance of alumni feedback, obtaining statistical significance, especially in regards to NAPLEX scores, posed barriers to this study. Several aspects of this study were statistically significant and should be used as reference to address ways to improve NAPLEX scores in future PharmD classes. That said, the statistically insignificant results still present valuable feedback and reflections that can be used to help improve the PharmD curriculum.
    • Implementation of outpatient high dose cytarabine (HiDAC) consolidation chemotherapy in acute myeloid leukemia (AML) patients in the outpatient setting: an institutional perspective on the safety and outcomes of transitioned chemotherapy under an alternative payment model

      McBride, Ali; Jafari, Leila; Hussain, Jubair; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Introduction: High-dose cytarabine (HiDAC) consolidation is required by patients with acute myeloid leukemia (AML) who achieve complete remission with induction therapy. HiDAC consolidation is the standard of care and is based on age and risk stratification. Traditionally, consolidation therapy has been administered in the inpatient (IP) setting. The rising cost of inpatient care, alternative payment model implementation, and patient preference has driven institutions to consider transitioning consolidation therapy to the outpatient (OP) setting. However, the safety and feasibility of OP HiDAC consolidation therapy is not well established. The University of Arizona Cancer Center (UACC) developed an OP approach to administer hematologic chemotherapy regimens in the outpatient setting. We hypothesized that OP administration of HiDAC consolidation therapy is safe and efficacious and has large cost-savings implications under alternative payment model pilots, such as the oncology care model. In this study, we address the safety, efficacy, and cost-savings of OP versus IP HiDAC consolidation therapy at the University of Arizona Cancer Center. Methods: We conducted a retrospective chart review on high-risk Myelodysplastic syndrome (MDS)/AML patients who were 18 years or older and received HiDAC consolidation therapy at UACC following induction therapy from November 1st 2013 to June 1st 2019. Data collected included age, treatment history, clinic visits, and number of cycles received in the OP versus IP setting, supportive care, hospitalizations, and chemotherapy-related adverse events. Our OP HiDAC included timely administration at 7:30 in the morning and at 4:00 in the afternoon, over a one-hour infusion for all cytarabine doses on days 1, 3, and 5. Neurologic assessments were made before each dose was administered. Standard supportive medications were provided for each cycle. Growth factor support, if required, was administered the same day as the last dose of cytarabine. Results: We evaluated 30 patients at our cancer center who received a total of 82 cycles of HiDAC consolidation therapy, in which 18 and 64 cycles were administered in the IP and OP setting, respectively. The median patient age was 45 years (20-73) with 20% of patients over the age of 60, 6 patients harbored the FLT3 mutation and 7 patients were NPM1 positive. There were no significant differences in in age, ethnicity, and BSA. 8 patients received all of their HiDAC cycles in the IP setting, which totaled 18 cycles. 22 patients received all of their HiDAC cycles in the OP setting, which totaled 64 cycles. During the 64 OP cycles, 2 patients experienced neurotoxicity and 3 patients experienced conjunctivitis. Nausea/Vomiting was significantly lower in the OP versus IP setting (59% versus 100%, p-value 0.031). Infections requiring hospitalization occurred in 50% versus 75% in the OP and IP settings, respectively (p=0.221). Febrile neutropenia occurred in 77% and 75% of patients in the OP versus IP setting (p=0.896) requiring hospitalization during chemotherapy. Patients that received OP consolidation required hospitalization during chemotherapy. For patients, the mean distance to the University of Arizona Cancer Center was shorter for the OP setting compared to the IP setting (OP=10.46 miles, SD=9.27 miles vs. IP=48.39 miles, SD= 94.93 miles). The average length of stay (LOS) for IP HiDAC was 12.5 days (SD=4.3) in the IP setting (p=0.02) and the average outpatient ambulatory care visit for treatment was 3 days. The transition of HiDAC to OP setting led to a savings of 288 hospital days saved. This corresponded to a cost reduction of $$770,400 to our healthcare system. Conclusion: Based on this retrospective analysis, HiDAC consolidation therapy in the OP setting is a safe and effective treatment option for the management of AML patients in remission. OP HiDAC consolidation therapy reduces inpatient hospitalization for both young and old patients. OP HiDAC reduced adverse effects and LOS. Transitioning HiDAC to the OP setting led to a reduced overall cost of care model of AML treatment under an OCM based practice model. However, health care providers and patients need to be aware of potential risks and side effects. Administration of OP HiDAC may provide a unique opportunity for consolidation therapy for select patients with AML.
    • Impact of Medication Storage Location on the Administration Time for Levetiracetam Verse Phenobarbital in Neonatal Status Epilepticus

      Kurz, Ronda; Thomas, Chris; Lewandowski, Amanda; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: This study was an investigation of the time it takes to get anti-epileptic medication to the bedside of seizing neonates. The elapsed time from order placement to drug administration in neonates with status epilepticus was investigated for intravenous levetiracetam or intravenous phenobarbital. The primary outcome was to compare the time from order placement to drug administration between neonates that receive intravenous (IV) levetiracetam or (IV) phenobarbital. Methods: A retrospective single center chart review of neonatal patients (? 28 days) admitted to Phoenix Children’s Hospital from January 2018 to December 2018 who received either IV phenobarbital or IV levetiracetam as first line therapy for status epilepticus. Patients were categorized in two groups according to the medication the patient received first, phenobarbital versus levetiracetam. Main Results: Sixteen neonates were included (levetiracetam n=9, and phenobarbital n=7). The most common etiology of neonatal seizures was hypoxic-ischemic encephalopathy (HIE) (n =?8; 50%). The primary outcome of time (minutes) to complete the medication administration after order placement and verification of levetiracetam (58 minutes) was significantly greater (p = < 0.01) than the phenobarbital group (23 minutes). There was no significant difference between the two groups in terms of mechanical ventilation difference before and after drug administration, number of days in the NICU, number of days in the hospital stay, and number antiepileptic drugs of patients were on at discharge. Conclusions: With an increased total elapsed time for drug administration, levetiracetam’s administration time in the hospital did not provide a significant hinderance in outcomes in neonatal status epilepticus.
    • Evaluation of a Pharmacist-driven Immunization Protocol in Solid Organ Transplant

      Johnson, Katherine; Alam, Ruhani; Eastep, Tyler; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: To assess the attitudes of health teams regarding pharmacist recommendations for immunization adherence in kidney transplant recipients. To evaluate understanding of a pharmacist-led immunization protocol. Methods: We distributed a proprietary survey to assess health teams on their current immunization practices, understanding of the newly implemented pharmacist-led immunization protocol, and willingness to accept pharmacists’ immunization recommendations. Main Results: A majority of respondents (53%) endorsed understanding of the protocol (rated ‘somewhat understand’ or ‘completely understand’). A majority (53%) of respondents stated that they were ‘very willing’ or ‘extremely willing’ to accept pharmacist immunization recommendations. Conclusions: The protocol was well understood, and our respondents stated willingness to collaborate with pharmacists is encouraging. Non-response/incomplete surveys limit the usefulness of our data.
    • Patient Satisfaction within the Community Pharmacy Setting

      Urbine, Terry; Kebede, Zelalem; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
    • Retrospective Review Evaluating the Incidence of Febrile Neutropenia for Same-Day versus Next-Day Pegfilgrastim in Lymphoma Patients

      McBride, Ali; Bartels, Trace; Moore, Logan; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: To determine the incidence of febrile neutropenia in lymphoma patients receiving pegfilgrastim the same-day (D1) as chemotherapy and compare it to the next-day (D2) dosing of pegfilgrastim. Additionally, to determine the rates of dose delays or reductions, infections, and hospitalizations associated with D1 pegfilgrastim administration. Methods: Seventy-three patients who underwent treatment for lymphoma at the Banner/University of Arizona Cancer Center North Campus between November 1st, 2013 and June 1st, 2019 were evaluated through retrospective chart review. Patients must have been treated with either cyclophosphamide + doxorubicin + vincristine + prednisone + rituximab (R-CHOP) regimen or bendamustine + rituximab (BR) regimen while receiving D1 pegfilgrastim. This data was then compared results from Burris et al. where patients received D2 pegfilgrastim. Main Results: Patients who completed D1 R-CHOP regimens where compared to historical D2 R-CHOP regimens. Chi-square analysis showed no significant differences between the two groups for febrile neutropenia (p = 0.39) and cycle 1 grade 4 neutropenia incidence (p = 0.28). Patients who received D1 BR chemotherapy had a lower incidence of all primary and secondary outcomes compared to those who had received D1 R-CHOP chemotherapy. Conclusions: The incidence of febrile neutropenia in lymphoma patients receiving D1 administration was comparable to historical data that utilized D2 administration. The results demonstrate the need for further investigations between D1 and D2 administration of pegfilgrastim. The present data indicates that the risk for chemotherapy induced complications is lower with the BR regimen versus R-CHOP for the treatment of lymphoma.