• Club Medbox: An Evaluation of a Pharmacist Run Adherence Group Focused on Improving Medication Therapy Adherence and Disease State Management in HIV Positive Patients

      Katz, Michael; Perkins, Natalie A.; Glover, Jon; Mora, Joseph W.; Starkey, Kimberly J.; College of Pharmacy, The University of Arizona (The University of Arizona., 2009)
      OBJECTIVES: To evaluate Club Medbox, a pharmacist-run intervention in which a pharmacist addresses barriers to treatment that arise in patients with HIV via a weekly educational group session. METHODS: A retrospective chart review and patient interview were utilized to evaluate Club Medbox member characteristics and changes in clinical HIV markers over the course of membership; and survey instruments were used to assess patient-perceived impacts of Club Medbox on overcoming barriers to antiretroviral therapy adherence, general health, social support, and disease- state comprehension. RESULTS: A total of 28 patients met inclusion criteria and were included in this study. HIV-ASES scores were significantly increased (p <0.001). SF-12 scores showed significant improvement for the physical health domain (p <0.001) with minimal changes to the mental health domain (p=0.949). CD 4 counts, CD 4%, and undetectable viral load values were all observed with an upward trend from baseline until after intervention with Club Medbox. Social and educational participant influence were shown to improve based on interview responses (p <0.001). CONCLUSIONS: This investigation showed significant improvement in the confidence of participants to adhere to treatment plans when barriers are present, self-perceived physical health, disease state management, patient-perception of feelings of social support, and patient-understanding of HIV as a disease state from baseline until after Club Medbox affiliation. This study did not show an influence of Club Medbox participation on self-perceived mental health. Club Medbox should be considered an effective intervention in the improvement of medication therapy adherence and disease state management in HIV positive patients.
    • Evaluation of Adherence to Treatment Standards and Clinical Outcomes Associated with Prophylaxis of Venous Thromboembolism in Hospitalized Patients at University Medical Center in Arizona

      Katz, Michael; Baggs, Jennifer; Chang, Grace; Li, Jinwen; College of Pharmacy, The University of Arizona (The University of Arizona., 2009)
      OBJECTIVES: To assess whether patients at University Medical Center (UMC) in Arizona who have indications for venous thromboembolism (VTE) prophylaxis receive treatment, determine whether appropriate pharmacologic VTE prophylaxis is implemented, and analyze the incidence of VTE associated with prescribed regimens. METHODS: Data were derived from a retrospective chart review on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis. Two risk assessment models were used to evaluate adherence to treatment standards: the 2008 American College of Chest Physicians (ACCP) evidence-based consensus guidelines and the Caprini score. Clinical outcomes were evaluated with regard to proper thromboprophylaxis including assessment of appropriate time, type, intensity, and duration of treatment. RESULTS: A total of 366 patients met inclusion critera. Based on the Caprini score, 94% of patients were judged to be at risk for VTE. Of those at risk, 90% received thromboprophylaxis; however, only 35% of treated patients received proper thromboprophylaxis. Ten patients (2.7%) experienced a VTE during their hospital stay or within the following 6 months after discharge. There was not a significant difference in incidence of VTE with respect to treatment versus no treatment or proper versus improper prophylaxis (p=0.15 and 0.65, respectively); however, a favorable trend in incidence of VTE was observed for treated patients and patients treated with correct thromboprophylaxis based on risk assessment. CONCLUSIONS: Most patients at UMC who were indicated for VTE prophylaxis received treatment; however, the type, intensity, and duration of thromboprophylaxis were often inappropriate despite the existence of various guidelines.
    • Evaluation of Post-Operative Venous Thromboembolism Prophylaxis in Lung Transplant Patients

      Katz, Michael; Cosgrove, Richard; Douglas, Randi M.; Parker, Lauren N.; Katz, Michael; Cosgrove, Richard; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set at the University of Arizona Medical Center (UAMC) in April 2007. Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 – October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type (including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year post-discharge. Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the post-order set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007 protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not significantly reduce event rates or readmissions due to VTE. Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of prophylaxis.
    • An Evaluation of the HIV/AIDS Awareness at the University of Arizona College of Pharmacy

      Katz, Michael; Slack, Marion; Pugliese, Leanna; College of Pharmacy, The University of Arizona (The University of Arizona., 2006)
      Objectives: The HIV/AIDS Awareness series aims to broaden the College of Pharmacy’s impact and service to the community by educating and increasing awareness about the many facets of HIV/AIDS not only locally, but also globally. Our innovative educational series entitled “AIDS Awareness Week,” will enable many students and faculty to come together to learn in a community forum setting. Our purpose is to describe the general activities included in the Week, as well as to describe the general reaction to the program. Methods: A questionnaire was developed and administered every day of the week long series from November 28 – December 1 2005 at the University of Arizona, College of Pharmacy. Results: Data was utilized for a total of 222 participants to the 2005 AIDS Awareness Week educational series. Of the 222, 41.4% (n=92) were male, and 59% (n=130) were female. The following faculties were represented during the week; College of Pharmacy 72.5% (n=161), the College of Nursing 14% (n=30), the College of Medicine 7.2% (n=16), the College of Public Health 1.4% (n=3), and those from “other” programs at 1.4% (n=3). Of those in attendance, 94% (n=209) were students, 2.3% (n=5) were faculty, 2.3% (n=5) fell into the “other” category, and 1.4% (n=3) were health professionals. Of significance was the number of “return” participants to the different 2005 educational series. The number of “return participants” was as follows: On day 2, 63.3% (n=38) of the 60 in attendance had been to the previous day. On day 3, 48% (n=30) of 63 participants had been to Day 1, and 62% (n=39) had also attended Day 2. On Day 4, 52% (n=26) of the 50 in attendance had attended Day1, 58% (n=29) for Day 2, and 44% (n=22) for Day 3. Implications: Overall, the series went very well and attendance was high. Positive feedback regarding the events was taken via anecdotal comments and that people returned to each session. This program is easily duplicated and can be used as a template in any university setting to promote awareness of sensitive subjects as well as foster community learning and relationships between the professions. It is hoped that this educational series will aid in bridging the gap within healthcare professionals, as well as provide an open forum for students from different backgrounds to come and learn the information together.
    • n Evaluation of the Diagnosis of Iron Deficiency Anemia in a Hospital Population

      Katz, Michael; Mellen, Chad; Seifter, Nik; Shafer, Tim; College of Pharmacy, The University of Arizona (The University of Arizona., 2008)
      Objectives: To examine the utilization of the various laboratory tests in diagnosing iron deficiency anemia and determine the proportion of patients receiving unnecessary iron supplementation. Methods: Included in the descriptive study were 126 adult patients with a diagnosis of iron-deficiency anemia determined by ICD9 codes at the University Medical Center (UMC) in Tucson, AZ. Demographic and clinical characteristics were collected by chart review and analyzed by calculating means, standard deviation, and range for patient’s age, iron dose, and lab values. The study also examined the percentage of each lab value (serum iron, transferrin, transferrin saturation, serum ferritin, and/or hemoglobin/hematocrit) used to diagnosis iron deficiency anemia and the percentage of patients found below common references ranges for each serum iron laboratory test were calculated. Results: The average age of the iron deficiency patient was 55 with an average daily elemental iron dose of 108.1 mg with a standard deviation of 50.0. The majority of the laboratory tests were utilized over 50% of the time, with the exception of transferrin (49.6%), transferrin saturation (44.8%), and ferritin (46.4%). The laboratory test with results below the reference range the least percentage of the time was ferritin at 13.8%. The hematocrit (95.1%), hemoglobin (93.6%), serum iron (92.6%), and transferrin saturation (91.1 %) were below the reference range in a high proportion of the patients. Conclusions: It appears that physicians in a hospital setting are not obtaining or utilizing the correct iron laboratory tests in the diagnosis of iron deficiency anemia, resulting in unnecessary iron supplementation.
    • Pharmacists’ Attitudes towards Reporting Adverse Drug Events in the United Kingdom

      Katz, Michael; Patel, Rachna; College of Pharmacy, The University of Arizona (The University of Arizona., 2009)
      OBJECTIVES: To determine the likelihood of pharmacists in England of reporting adverse drug reactions (ADR), whether they are aware of the reporting processes, and what they believe the reasons for not reporting may be. METHODS: A survey containing five different scenarios of ADRs was distributed to licensed, community pharmacists around Surrey, England. The responses were analyzed using rates and chi-square. RESULTS: A total of 47 surveys were returned to the researcher. Of those, 72% of the participants were likely to report the adverse drug reaction in the scenarios provided. In addition, 87.5% of the pharmacists were familiar with the reporting procedures in place in the United Kingdom. A total of 51.9% were not able to distinguish between a major and minor adverse reaction. Finally, with a X2 value of 0.070, there was not a significant difference between males and females and the likelihood of reporting these errors (p=0.79). Similarly, there was no significant difference between the likelihood of reporting an event involving a pediatric patient vs. an adult patient with a X2 value of 0.275 (p=0.599). CONCLUSIONS: Most pharmacists were aware of the procedures involved in reporting ADRs in the United Kingdom and were likely to report these ADRs. Additionally, the most common reason predicted for not reporting was due to the lack of time pharmacists have to report these events. Regardless of gender, male and female pharmacists were equally likely to report ADRs.
    • The Usage of Smartphone and PDA Based Electronic Drug Databases Among Pharmacists

      Katz, Michael; Bluder, Steven; Katz, Michael; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: To assess the use of PDA/smartphone based electronic drug databases among pharmacists as it has changed over time. The working hypothesis is that the use of PDA/Smartphone based electronic drug databases has increased over time. Methods: A systematic review of the literature regarding the usage of PDA/smartphone based electronic drug databases among pharmacists using data that was obtained through literature searches. Main Results: Since 2006, the percentage of pharmacists that are using PDA/smartphone based electronic drug databases has increased. Conclusions: The usage of smartphones and PDA based electronic drug databases has increased among pharmacists since 2006 (p<0.05). Easier and cheaper access to the technology has likely led to the products being available to more pharmacists.
    • Utility of HealthProLink as a Tool by Pharm.D. Students on Experiential Rotations to Track Interventions

      Katz, Michael; DeMartin, Nikki C.; College of Pharmacy, The University of Arizona (The University of Arizona., 2005)
      Objectives: To compare the interest in and the utility of a clinical intervention documentation tool for Pharm.D. students and preceptors on the basis of gender, age, and years and type of practice. Methods: A web-based survey (pre and post) was administered to all willing subjects. The survey web page was accessed through email. Results: Pre-surveys were completed by 14 students and 4 preceptors. Post-surveys were completed by 3 students (only one of which used the tool) and one preceptor. Due to the poor response rate results on the post-survey and the preceptors pre-survey were not analyzed. For the students pre-survey there were no statistical differences between the men and women in regards to their age. No statistically significant differences were found for students thoughts on utility and usefulness of the documentation tool on the basis of gender. Also there was no statistical difference between the men and women about the likely hood of them using a documentation tool if it was available to them. Implications: This study found that students regardless of gender thought that a documentation tool may prove useful for preceptors and themselves. If a documentation tool was implemented it could provide important information of student activity to the preceptors as well as the College of Pharmacy.