• Access to Primary Medical Care among Patients with and without Mental Illness in a Rural Setting

      Hall-Lipsy, Elizabeth; Leutz, Kenneth; Elmer, Cody; Elmer, Sarah; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess access to and quality of primary health care services by individuals receiving meals at a food bank in a rural location using the Primary Care Assessment Tool- Short Form (PCAT-S). Also, to investigate whether individuals with a mental health condition at a rural community food bank receive different care compared to those without a mental health condition. Methods: The PCAT-S, a survey developed by John Hopkins University, was administered to evaluate care at first contact, ongoing care, coordination of care, and comprehensiveness of care. Demographics data (age, gender, health conditions, insurance status, etc.) was also collected. Results: The majority of our participants surveyed lived within an urban zip code (84.8%), had government insurance (81.4%), were male (61.9%), or were Native American (45%). The groups with the highest mean PCAT-S scores were participants with diabetes (mean score= 96.8), participants with no insurance (94.63), and participants who were female (91). The patient populations with the lowest scores were those with less than a high school education (63.11) with serious mental illness (64), or who had bipolar disorder (69). Groups with higher mean PCAT-S scores indicated more involvement with a primary care provider or overall better care within that section of the PCAT-S. Conclusions: Participants with a mental health condition may be receiving less healthcare than those without a mental health condition, especially in the coordination of care between healthcare services, as indicated by lower mean PCAT-S scores. Those living in a rural community, among our population, do not appear to be receiving less healthcare than those in an urban setting.
    • Assessing Mental Health Stigma Between Rural and Urban Pharmacists

      Hall-Lipsy, Elizabeth; Salgado, Crystal; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To explore whether rural pharmacists express more stigmatized attitudes towards patients with psychiatric disorders, compared to their urban counterparts. Methods: Data was collected from participants attending the AzPA Southwestern Clinical Pharmacy Seminar during a weekend in February, 2015, using a questionnaire adapted from the Mental Illness: Clinicians’ Attitudes (MICA) Scale v4. The questionnaire consisted of demographic and attitude assessment questions regarding patients suffering from psychiatric disorders across different domains (quality of life, fear of patients, admitting to having a psychiatric disorder, and more). Participants were also asked if they would be interested in taking a continuing education course on mental health. Results: The majority of participants that completed the study were women (75%) and identified racially as white (89%). Pharmacists practice settings were as follows: 79% of pharmacists worked in urban areas and 21% in rural areas. Rural pharmacists displayed significantly higher rates of stigmatized attitudes compared to their urban peers (mean scale score 37.65 vs. 40.15, p=0.049). Conclusions: Pharmacists that practice in rural settings expressed more stigmatized attitudes, compared to their urban counterparts, towards patients diagnosed with psychiatric disorders.
    • Assessing Self-Reported Quality and Access to Primary Care for Patients with Psychiatric Disorders

      Goldstone, Lisa; Hall-Lipsy, Elizabeth; Catalano, Natalie; Dewey, Brittney; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: (1) To assess the access to and quality of primary care for patients living with a psychiatric condition(s). (2) To identify demographic factors that may influence the access and quality of primary care services. Methods: Subjects were recruited at HOPE Inc., a behavioral health resource center, in Tucson, Arizona, during pharmacy student-run health fairs. Participants were surveyed using the Primary Care Assessment Tool (PCAT) a questionnaire developed by Johns Hopkins, which assess four domains of primary care. Participants were also surveyed about demographics, mental health diagnosis and their SMI designation. For objective (1): Descriptive statistics for each domain of the PCAT were performed to assess the level of access and quality of care, including comparison to a hypothesized score. For objective (2): Due to the small sample size only descriptive analysis of the demographic data was performed. Results: A total of 11 subjects were surveyed using the PCAT with an average score of 67.64±12.18. This was higher than the hypothesized score of 46. On average, in all four PCAT domains participants scored higher than the hypothesized, value. The lowest scoring domains were, “Care at first contact - Access” and “Coordination of care” (10.45±3.62, Hypothesized score: 8) and (12.36±5.82, Hypothesized score: 10) respectively. The highest scoring domain was “Care at first contact - utilization” (11.09±1.92, Hypothesized score: 12). Conclusions: This study helped to provide a framework for future studies of primary care services using the PCAT survey.
    • Assessing the Factors Involved in Provider Preference and Willingness to Pay for Informational and Screening Services

      Hall-Lipsy, Elizabeth; Rust, Jennifer; Heideman, Kalie; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: The purpose of this study is to assess rural community members in Cochise County, Arizona, to determine if healthcare screenings and informational sessions are desired by the community members for chronic disease states, and from which healthcare providers the community members prefer to obtain these services. Identify which health professional rural members are most likely to seek for healthcare screening. Identify which health professional rural members are most likely to seek for healthcare informational sessions. Determine if rural community members are willing to pay for healthcare screening and informational sessions. Methods: This descriptive study obtained data through 350 questionnaires distributed during selected Cochise County community events in late 2011. Main Results: 341 surveys were completed. The majority of results favored physicians with 47.7% of the people stating they would very likely attend a health care screening conducted by a physician. 34.5% responded they would very likely attend an informational session conducted by a physician. Of the respondents willing to pay for health screenings, 63.9% would pay $30 or less. 70.9% stated they would not be willing to pay for an informational session. However, the majority of participants, 61.3%, indicated they would utilize pharmacists for OTC questions. Regarding questions about prescription medications, 43.4% would go to pharmacists, and similarly, 44% indicated they use physicians. Conclusions: As seen from the results, pharmacists are underutilized by rural community members; except for OTC questions. Respondents with higher levels of education were also more likely to prefer and attend events held by pharmacists.
    • Assessing the Factors Involved in Provider Preference and Willingness to Pay for Informational and Screening Services

      Hall-Lipsy, Elizabeth; Rust, Jennifer; Heideman, Kalie; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: The purpose of this study is to assess rural community members in Cochise County, Arizona, to determine if healthcare screenings and informational sessions are desired by the community members for chronic disease states, and from which healthcare providers the community members prefer to obtain these services. Identify which health professional rural members are most likely to seek for healthcare screening. Identify which health professional rural members are most likely to seek for healthcare informational sessions. Determine if rural community members are willing to pay for healthcare screening and informational sessions. Methods: This descriptive study obtained data through 350 questionnaires distributed during selected Cochise County community events in late 2011. Main Results: 341 surveys were completed. The majority of results favored physicians with 47.7% of the people stating they would very likely attend a health care screening conducted by a physician. 34.5% responded they would very likely attend an informational session conducted by a physician. Of the respondents willing to pay for health screenings, 63.9% would pay $30 or less. 70.9% stated they would not be willing to pay for an informational session. However, the majority of participants, 61.3%, indicated they would utilize pharmacists for OTC questions. Regarding questions about prescription medications, 43.4% would go to pharmacists, and similarly, 44% indicated they use physicians. Conclusions: As seen from the results, pharmacists are underutilized by rural community members; except for OTC questions. Respondents with higher levels of education were also more likely to prefer and attend events held by pharmacists.
    • Assessment of Pharmacists’ and Pharmacy Students’ Confidence and Knowledge of Common Asthma Inhaler Devices

      Phan, Hanna; Spencer, Jenene; Hall-Lipsy, Elizabeth; Luu, Michael; Nguyen, Vy Thuy; Lee, Yvonne; Chandler, Krystal; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To compare pharmacists’ and pharmacy students’ confidence and knowledge level with educating/counseling adolescents/adults, caregivers, and children on appropriate technique and use of common inhaler devices. To identify possible factors that may influence pharmacists’ and pharmacy students’ knowledge and confidence level with educating/counseling patients/caregivers on appropriate technique and use of common inhaler devices. Methods: A survey study using a questionnaire tool consisting of confidence level and knowledge-based questions was distributed to first through fourth year pharmacy students as well as pharmacists registered through the Arizona Pharmacy Association. Main Results: Pharmacists were more confident and knowledgeable with their ability to educate on appropriate inhaler device technique compared to pharmacy students. Both the pharmacist group and pharmacy student group reported health fairs and coursework highest as contributing factors to their knowledge. In general, pharmacists and students were more comfortable with their knowledge of inhaler devices that are more commonly prescribed. Conclusion: Confidence and knowledge level with their ability to educate on appropriate inhaler device technique in all devices and demographics of patients were higher in the pharmacist group than the pharmacy student group.
    • Evaluating Diabetes Interventions in American Indian Populations, A Systematic Review

      Hall-Lipsy, Elizabeth; White, Sterling; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: Conduct a comprehensive and systematic review to identify and describe studies from October 2010 to May 2012 that have addressed diabetes interventions in American Indian populations and assess the impact those interventions had on improving humanistic and therapeutic outcomes in preventing or treating diabetes in American Indians. Methods: Studies published between 5 October 2010 and 30 May 2012 that described diabetes interventions or programs in American Indian populations were identified via electronic searches of PubMed, CINAHL, IPA, Cochrane, PsychINFO, Web of Science, and ERIC using key search terms related to (and MeSH terms where applicable) diabetes, interventions, medication adherence, diet, exercise, blood glucose, cholesterol, blood pressure, North American Indians, American Indians, Native Americans, and Alaska Natives. Articles were reviewed and were excluded if the study had no comparison group, was not interventional or programmatic in nature, took place outside the US, study population was < 50% American Indian, or did not report on patient-related outcomes. Data on study characteristics, patient characteristics, and study outcomes were extracted. Main Results: A total of five studies were included. Positive, significant effects were reported on A1c in 40% (n=2), cholesterol in 40% (n=2), blood pressure in 40% (n=2), weight/BMI in 20% (n=1), blood glucose monitoring in 20% (n=1), diet in 20% (n=1), and diabetes knowledge and health literacy in 20% (n=1). Conclusion: The literature review had minimal results. Of those included, the majority of diabetes interventions were educational-related, observational in design, assessed only adults, and study populations were primarily female. Few of the included studies interventions demonstrated significant improvements in diabetic outcomes. Continued research and efforts to further improve diabetes management within the American Indian community is needed.
    • Evaluating Perceived Barriers and Challenges to Interprofessional Education and Practices Amongst Rural Health Care Providers: a Focus Group Approach

      Hall-Lipsy, Elizabeth; Roth, Carrie; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To facilitate a discussion among various healthcare professionals about the facets of interprofessionalism that occur, or do not occur, in a rural acute healthcare setting, and how interprofessionalism could be integrated into the facility’s current healthcare professional student programs. Methods: A focus group was conducted with 8 participants lasting about 45 minutes. Participants were one of three different professions (nurse, medical doctor, or pharmacist) and included administrators as well as staff employees. Six questions were discussed among participants and the answers from each participant were scripted onto a word document. This document was thematically analyzed and compared and contrasted to a previous study, which asked the same six questions in a different rural acute healthcare site. Results: The main findings of this study were that workforce shortage, lack of computerized physician order entry (CPOE), and lack of a uniformity throughout the hospital affected interprofessional practice, learning, and education. Conclusions: Perceived barriers of interprofessional practice at Canyon Vista Medical Center included: poor communication, understaffing, lack of a unified, computerized EHR throughout the hospital, and unclear policies. Some proposed ways to overcome these barriers include having a full staff, creating a unified electronic health record (EHR) system, offering interprofessional learning opportunities, and providing employees the opportunity to gain experience in departments other than their own.
    • Evaluating Practice-Based Research Network (PBRN) Websites Using an Information Extraction Form and Interviews of Website Webmasters

      Hall-Lipsy, Elizabeth; Rahimzadeh, Sheida; Ramirez, Veronica; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: To evaluate and describe the Agency for Healthcare Research and Quality (AHRQ) affiliated practice-based research network (PBRN) websites to determine the best qualities regarding format, content, and accessibility using a developed PBRN website information extraction form. Methods: A PBRN information extraction form was developed to assess the format, content, and accessibility of each AHRQ-affiliated PBRN website. Each student investigator completed an electronic copy of the extraction form for each PBRN website to confirm consistency of findings. A phone interview was then conducted with the webmasters of the PBRNs with the highest scores to determine the influences and challenges those webmasters faced during the development of their PBRN websites. Main Results: The information extraction form was completed for each of the 104 active PBRN websites in the U.S. The most common elements seen on the PBRN websites were site map, email address, mission statement, phone number, and search toolbar. The inter-rater agreement between the two student investigators for the data collected was 84 percent. Regarding the webmaster interviews, the majority of the webmasters believed that the single most important factor in creating a successful PBRN website was identifying the audience of the PBRN and making the material appropriate for that audience. Conclusion: The developed information extraction form was used to successfully evaluate and describe the AHRQ-affiliated PBRN websites. Audience identification is important in order to provide appropriate content, as well as in the development of an effective PBRN website.
    • Evaluation of Student and Hospital Administrator Perceptions of Student Involvement in Completion of Community Health Needs Assessments

      Hall-Lipsy, Elizabeth; Olson, Julia; Griswold, Cassia; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: The objectives of this study were to (1) evaluate student perceptions of completing a Community Health Needs Assessment (CHNA) and (2) determine hospital administrators’ awareness of potential student roles and interest in future student involvement in completing their mandated CHNA. Methods: Rural Health Professions Program (RHPP) participants who completed the CHNA course were emailed a link to a survey addressing demographics and satisfaction with the CHNA experience. Rural, not-for profit hospitals who were members of the Arizona Hospital and Health Care Association were selected for inclusion. Representatives from eligible hospitals completed a telephonic interview regarding their CHNA process, results, and interest in collaborating with RHPP students. Results: Twenty-nine students completed the survey (60% participation). In thematic analysis addressing overall satisfaction with the process, the top response was that it was a good learning experience (9 responses). Participants strongly agreed that communities can benefit from student involvement (65%) and 83% believed their CHNA could benefit the community. Of 19 eligible hospitals, 12 completed phone interviews (63% participation). The most commonly reported obstacles to completing a CHNA were: lack of resources, time, and community participation. Pharmacy was involved in the process at five of the facilities (41%). After describing the RHPP, 10 respondents indicated interest in student involvement in their CHNA (83%). Conclusions: There is potential for a mutually beneficial student-community collaboration, providing hospitals with additional resources while enhancing student engagement and community impact. This partnership could also increase pharmacy representation in the CHNA process, as less than half of hospitals reported pharmacy involvement.
    • Factors Affecting Prescribing Behaviors of Benzodiazepines and Antipsychotics to Patients with Mental Health Diagnoses in an Academic Medical Center Emergency Department

      Goldstone, Lisa; Hall-Lipsy, Elizabeth; Itantaffi, Katrian; Ngan, Maie; Howden, Liian; Goldstone, Lisa; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2015)
      Objectives: To determine whether disparities exist among mental health patients admitted to the emergency department in regards to the prescribing patterns of injectable benzodiazepines and antipsychotics. Methods: A retrospective chart review was performed to evaluate patients with mental health diagnoses who received an injectable antipsychotic or benzodiazepine while in the emergency department of an academic medical center. A report was generated of all injectable antipsychotics and benzodiazepines removed from the emergency department Pyxis machines from November 1, 2013 to January 31, 2014. Data from the patient medical record included the patient’s age, height, weight, gender, race/ethnicity, insurance information, mental health diagnosis, evidence of substance abuse, how they arrived in the emergency department, their length of stay in the emergency department, any signs of aggressive behavior (adapted from the Overt Aggression Scale), information about each injectable antipsychotic or benzodiazepine that was administered was recorded including the name of the medication, dose, route of administration. If the patient received multiple doses of the same medication during their stay, the total dose and the total time receiving the medication was also recorded. The prescriber’s gender and whether they were a resident or an attending physician was also recorded for each medication administered. Results: A total of 98 patient charts were reviewed and analyzed. Mental health diagnoses were broken down into categories of psychiatric disorders (39.8%), bipolar disorders (74.5%), mood disorders (40.8%), and personality disorders 54.1%). Of the 98 patients reviewed, 68% had a documented substance abuse, with 62% having a positive urinalysis for alcohol, illicit drugs, or opiates. The majority of the patients were white (64.3%). The next largest racial/ethnic categories were Hispanics (12.2%), Native Americans (8.2%), and African Americans (6.1%). There were 54 males and 44 females. Benzodiazepines comprised 74% of the medications administered with lorazepam being the most frequently administered medication overall at 63.4%. Haloperidol was the second most frequently administered medication at 22%. Initial Chi Square analysis did not yield any significant results with regards to race and prescribing patterns, gender and prescribing patterns, or insurance and prescribing patterns. Conclusions: Patients with mental health diagnoses suffer from disparities within health care, and when these patients fall under other demographic groups such as racial/ethnic minorities and low socioeconomic status, the disparate treatment they receive could be even greater. Several limitations to this study including a small sample size and lack of geographical diversity resulted in a lack of statistically significant results, and our findings may not be generalizable to other patient populations.
    • Grapefruit-Statin Interactions: Patient Awareness, Knowledge and Contributing Factors

      Spencer, Jenene; Hall-Lipsy, Elizabeth; Hannum, Cameron; Hawkins, Kevin; Spencer, Jenene; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: The goals of this study were: to assess patients’ knowledge of grapefruit interactions when taking statin class (dyslipidemia) medications, to identify any pertinent demographic characteristics that may influence knowledge of grapefruit statin interactions, and to identify patient preferred sources of health information. Methods: Questionnaires were administered at community health fairs during the academic school year 2014 through 2015. The survey addressed grapefruit consumption, frequency and amount, for both whole fruit and juice; examined knowledge of the potential for harmful interactions of grapefruit juice with statin medications; and how or where the participant learned this information. Results: A total of 74 participants completed surveys, of which, 72 submitted fully completed surveys, mean age was 64 (SD=+/- 15.6), 71.2% were female (N=52), and 78.1% were white. Of those surveyed, 63.5% (N= 47) reported consuming grapefruit in the past 12 months, and 36.1% (N=26) reported taking a statin. Those taking statins, 50% (N=13) reported consuming grapefruit as well. The majority of people, 61.3% (N=45), reported obtaining health related information from healthcare sources. Those with a college education were more likely to have consumed grapefruit in the last 12 months (X2=4.88, p=0.027) and to have ever consumed grapefruit (X2 =4.40, p=0.036). Conclusions: The majority of the health fair attendees surveyed were highly educated, reported having health insurance, had consumed grapefruit in the past year, and had heard about grapefruit-drug interactions.
    • Identifying inducements and barriers in developing a community health center pharmacy practice based research network

      Hall-Lipsy, Elizabeth; Thompson, April; Olson, Charity; College of Pharmacy, The University of Arizona (The University of Arizona., 2010)
      OBJECTIVES: To identify and describe practical incentives and barriers for community health center pharmacists in adopting a practice based research network (PBRN) that facilitates sustainable collaboration. METHODS: Directors of pharmacy at Community health centers listed as members of Arizona Association of Community Health Centers (AACHC), with on-site pharmacies, were contacted via telephone. During initial contact an IRB approved script was used to recruit the pharmacy director’s participation, at which time the subject’s disclaimer form was read and an appointment for a future phone interview was scheduled. Phone Interviews were conducted using a standardized questionnaire, and all results were manually recorded on a standardized data collection form. Data collected included, site specific information including the: educational background of the pharmacy director, and his or her perceived inducements and barriers to participating in a pharmacy based PBRN with the University of Arizona. RESULTS: Phone interviews were completed by 8 directors of pharmacy, 4 women (50%) and 4 men (50%). A total of 5 participants (62.5%) had a BS degree, 2 (25%) had PharmD degrees and 1 (12.5%) had both as BS and a PharmD degree. The mean length of time in current position was 5.56 yrs (SD= 4 yrs.). 75% of the participants indicated that they considered working with the University of Arizona (UofA) as an inducement, the same number of participants felt that their staff and practice as a whole would also consider it an inducement. Overall participants indicated that both their personal (75%) and staff‘s (87.5%) motivation to improve the pharmacy profession was considered an inducement, as well as their opportunity for professional growth (75%). All of the participants (100%) indicated they did not have adequate staffing to support research at this time and therefore felt it was a barrier to participation. When asked about resources as a whole, including staff, time and technology 87.5% of the participants felt this was a barrier. Other common barriers were; anticipated time requirements (75%), current schedule/time allowances (75%), staff’s outside commitments (75%). Out of the 8 participants only 2 (25%) are currently participating in PBRNS at this time, 3(37.5%) have research ideas that they are interested in working on, and 3(37.5%) indicated that they were not currently participating nor did they have any current interests. The major themes identified as inducements to participation were patient benefit, time/staffing involvement, and professional growth. CONCLUSIONS: The most common barriers to participating in a PBRN were: working with the UofA, motivation to improve the profession of pharmacy and the opportunity for professional growth. The most common inducements were staffing, current resources, anticipated time requirements, current schedules and outside commitments.
    • The impact of 90-day blister pack refill and patient education on compliance and blood pressure control in a Federally Qualified Health Center

      Hall-Lipsy, Elizabeth; Lopez, Dania; Flores, Randall; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Purpose: The purpose of this study is to examine and evaluate the impact of: 1) a pharmacy managed 90-day blister package refill on adherence and 2) educational intervention on medication adherence plus blood pressure outcomes. Introduction: Hypertension is one of the most common health condition amongst adults in the US. It is most often managed with the use of antihypertensive medications. Non-compliance to medication is often one of the biggest barriers in the management of hypertension and impacts health and increased health care costs. Community health centers like Mariposa Community Health Center in rural locations often have difficulty improving their patients’ medication adherence. Different strategies have been developed in order address medication adherence and improve health outcomes. Methods: A prospective, randomized controlled trial study that measured and compared adherence and blood pressure (BP) values of patients enrolled in a 90-day blister pack refill who participated in an educational workshop about hypertension. Participants completed a knowledge test survey before and after the educational workshop as well as an ASK-12 survey in order to identify potential barriers that affect medication adherence. Randomization was done utilizing a block randomization method. Adherence was calculated utilizing portion of days covered (PDC) formula. BP was analyzed utilizing a paired T-test. Knowledge and ASK-12 surveys were analyzed utilizing Wilcoxon signed-rank test. Results: In the first 90-day period, systolic blood pressure (SBP) was significantly decreased by mean of 6.84mmHg (p=0.05, 95% CI -.078-13.77). Diastolic had a similar decreasing trend but was not statistically significant (p=23 95% CI -2.42-9.04). 93.3% of the participants were adherent to their antihypertensive medications (PDC>80%). Pre and post knowledge surveys did not show any significant difference in the first 90 days. Questions 3 and 7 of the ASK-12 survey had a significant difference (p=0.021, p=0.15, 95% CI) in the first 90-day period. CONCLUSION: The number of patients vs those who consented yielded a less than desirable turnout limiting the intervention and making all those who consented assigned to the 90-day refill group limiting our data and having a comparison group. A significant decrease in SBP from their baseline BP was observed.
    • The Impact of the Affordable Care Act and Medicaid Expansion Program on Emergency Room Visits for Patients with Anxiety Disorders

      Goldstone, Lisa; Hall-Lipsy, Elizabeth; Kaiser, Monica; Goldstone, Lisa; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2015)
      Objectives: Characterize all patients in the emergency room diagnosed with anxiety disorders from 11/01/2013 until 5/31/2014 to identify insurance coverage and demographic trends. Methods: Retrospective descriptive study of patients who present to the emergency department between 11/01/2013 – 05/31/2014 and discharged with a primary documented diagnosis of an anxiety disorder. Age, race, and gender were recorded in addition to insurance coverage. Results: 406 visits were reviewed: 212 (52.2%) males and 194 (47.8%) females. Average age per visit: 40.34 (SD=13.388). Race recorded with each visit: 189 (46.6%) white, 146 (36.0%) Hispanic, 42 (10.3%) African American, and 29 (2.2%) other. The most common insurance coverage was Medicaid at 63.3%, while 6.4% of visits had no insurance coverage. There was a significant difference in the distribution in number of ED visits between genders (Mann-Whitney U=17,407.5, p=0.007, sig ≥0.05). A Kruskal-Wallis Test showed a significant difference in the number of ED visits between racial groups X²=43.434, p=0.000 as well as a significant difference between Medicaid and other insurance groups X²=37.778, p=0.021. Conclusions: Men appear to have a higher frequency in anxiety symptoms requiring an ED visit than women do. White patients tend to have a greater frequency in anxiety symptoms followed by Hispanic patients. Medicaid tends to be the most prevalent insurance coverage used.
    • Perspectives of Rural and Non-Rural Community Pharmacists in Pediatric Dosing and Recommendations

      Phan, Hanna; Hall-Lipsy, Elizabeth; Hu, Jackie; Lin, Grace; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess the perceived confidence level of community pharmacists in utilizing weight-based dosing, dispensing prescriptions, counseling, and recommending over-the-counter medications for the pediatric population in rural and non-rural settings. Methods: A 33-item questionnaire generated through REDCap was distributed to 11,280 pharmacists registered with the Arizona State Board of Pharmacy via email from March 14 to April 4 of 2017. The survey collected information on the participants’ experiences in managing pediatric prescriptions and demographics. Results: Of the 11,280 surveys distributed, a total of 857 responses were submitted by the end of the survey period (7.6%) and 482 responses were included in the analysis; 49 (10.2%) were practicing in rural areas and 433 (89.8%) were practicing in non-rural areas (including urban and suburban) in Arizona. There was no significant difference in the rural group compared to the non-rural group regarding experiences with dispensing pediatric medications. In regards to the confidence level, there was a significant difference between the two groups in calculating and recommending weight-based dosing for prescription and OTC pediatric medications (p = 0.022 and 0.031, respectively) and identifying a dosing error in pediatric prescriptions (p = 0.016). Conclusions: Community pharmacists practicing in rural and non-rural settings in Arizona had similar experiences with dispensing pediatric medications and confidence levels in managing medications for pediatric patients.
    • Research Interests of Pharmacists in a Community Based Practice Based Research Network

      Hall-Lipsy, Elizabeth; Jastrzab, Rebecca; Juliano, Frank; College of Pharmacy, The University of Arizona (The University of Arizona., 2010)
      OBJECTIVES: Describe the characteristics and research interests of Community Health Centers (CHC) pharmacists and pharmacies in a pharmacy based practice based research network (PBRN). METHODS: Pharmacy directors of eight Arizona CHC pharmacies were initially contacted by telephone and asked to participate in a survey. The survey was then sent to these directors via email and a second telephone conversation was set up to re-­‐administer the survey and gather the answers to the questionnaire. The questionnaire consisted of demographic, clinical and practice related questions targeted at identifying areas of interest for research in developing a community pharmacy practice based research network (PBRN). RESULTS: The data regarding the demographics and characteristics of the Arizona CHC pharmacies, pharmacists, and patients showed that only two pharmacies served more than 300 patients per day and dispensed more than 400 prescriptions per day. The data found that an average of 46% of the patients that went to these pharmacies did not consider English as their primary language and that an average of 49% of the patients were Hispanic/Latino. The data collected regarding the clinical interests of these pharmacies showed that asthma had the highest level of clinical interest among the eight CHC pharmacies (average rank = 3.1). For the public health interests of the CHC pharmacies, patient adherence/compliance was ranked the most important (average rank = 3.1). In regards to internal practice site interests job satisfaction was the most highly ranked interests among these CHC pharmacies (average rank = 3.1). CONCLUSIONS: The data suggests asthma, job satisfaction and patient compliance/adherence are the top areas of interest in the clinical, internal worksite, and public health sectors. The data collected from this study will help to establish a pharmacy based PBRN in Arizona and provide a starting point in terms of research topics that will be explored. The establishment of an Arizona pharmacy based PBRN is very important since it will provide cohesiveness between research and community based practice of Community Health Centers in Arizona and is a step in the right direction in terms of growth of these centers.
    • A Systematic Review of the Impact of Public Mental Health Benefit Changes on Patients with a Serious Mental Illness

      Goldstone, Lisa W.; Hall-Lipsy, Elizabeth; Schnarr, Marjanne; Valenzuela, Allison; Goldstone, Lisa W.; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: The specific aim of this study was to assess the impact of public mental health benefit changes on patients with a serious mental illness. Methods: A comprehensive literature search was conducted using several databases. Articles that were included in the analysis met the following inclusion criteria: 1) Study conducted in the United States 2) Study population composed of adults (≥18) with a diagnosis indicative of a serious mental illness (psychotic disorders, bipolar disorders, major depressive disorder, anxiety disorders, dysthymic disorder, or a personality disorder) 3) Study evaluated a change or discontinuation of mental health services, 4) Study reported outcomes. Main Results: Of the 117 studies originally identified, 27 met all the inclusion criteria. Data was then extracted from each study regarding the design of the study, patient demographics, and impact of the various outcomes. Five studies looked at the implementation of prior authorizations required for psychiatric medications, which all showed increased rates of treatment discontinuation. Two of these five studies also looked at the impact on emergency department (ED) visits and hospitalizations with both studies showing increased ED visits, but no effect on hospitalizations. Three studies looked at the implementation of Medicare Part D, which all showed increased rates of medication access problems and increased rates of ED visits. Other studies that examined medication access issues found increased rates of suicide ideation or behavior, increased rates of treatment discontinuation, and increased rates of ED visits. Conclusions: Given the amount of variability among the studies, it is difficult to determine the impact specific benefit changes have on patients diagnosed with a serious mental illness. In order to draw conclusions regarding specific benefit changes, more studies looking at similar outcomes need to be conducted. This is critical as the studies examined, in general, showed negative outcomes for patients with a serious mental illness when mental health benefit changes were implemented.
    • Systematic Review of Type 2 Diabetes Interventions in Native Americans: An Emphasis on Reported Limitations, Funding Sources, and Community Involvement      

      Hall-Lipsy, Elizabeth; Corrales, Teri L.; Hall-Lipsy, Elizabeth; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: This study assessed the extent to which American Indians were involved in the research process (i.e. design, implementation, analysis, and dissemination) in relationship to funding sources and reported limitations in research interventions that addressed diabetes, as well as research method or design. Methods: Systematic searches of The Cochrane Library, PubMed, CINAHL, International Pharmaceutical Abstracts (IPA), Web of Science, ERIC, and PsychINFO identified studies focused on type 2 diabetes in American Indians published between October 5, 2010 and April 30, 2012. Studies selected for inclusion were those that were interventional or programmatic in nature, used a comparison group for statistical analysis and reported patient level or patient related outcomes. Data were extracted and analyzed for study characteristics, reported limitations, funding sources, and extent to which the community was involved in the research process.       Main Results: A total of 6 studies were included. There was no difference between American Indian involvement in the research process with respect to funding sources and reported limitations (p = 0.17 and p = 0.23, respectively). The majority of studies were conducted in a clinic setting (33.3%) on tribal/sovereign land (66.7%). Study design was evenly split between randomized controlled trials and observational studies (50% for both). The most frequently reported intervention was combination/multimodal (50%).       Conclusion: American Indian involvement in the research process was not impacted by either funding sources or reported limitations.