• Assessing Adherence to the Tetanus, Diphtheria and Pertussis Vaccination Guidelines at a Federally Qualified Health Center Before and After a Clinical Pharmacist Intervention

      Kennedy, Amy; O'Brien, Dawne; Santa-Cruz, Ashley; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: Tetanus, diphtheria, and pertussis are diseases, which are preventable through proper vaccination. In spite of the availability these vaccines, however, there has recently been a surge in the number of pertussis cases in the United States. The objective of this study is to determine provider adherence to tetanus, diphtheria and pertussis guidelines set forth by the Advisory Committee on Immunization Practices in a primary care setting before and after a clinical pharmacist intervention. Methods: A retrospective cohort of chart reviews was conducted between January 1 – September 30, 2013 to determine immunization adherence to tetanus, diphteria, and pertussis vaccination guidelines. A clinical pharmacist then preformed a series of cross-sectional chart reviews as an intervention. Following the intervention, a retrospective chart review was conducted to evaluate if Tdap vaccination rates improved between March 17-23, 2014. Main Results: Overall immunization rates greatly improved following the intervention (p<0.0001; x2=44.988). For non-pregnant adults between the ages of 19-64 the vaccination rate improved from 26% to 61.1% (p<0.0001; x2=47.07). A statistically significant improvement was not seen in the groups with patients 65 or older or pregnant women (p>0.05). Tdap vaccination status was appropriately evaluated and vaccinations given by primary doctors improved from 17.7% to 61.2% and those prescribed by nurse practitioners improved from 22.4% to 56.3%. Conclusion: Intervention by a Clinical Pharmacist helped improve overall provider adherence to the tetanus, diphteria, and pertussis vaccination guidelines.
    • Assessment of Ambulatory Care Practice in Adult and Pediatric Patients

      Phan, Hanna; Kennedy, Amy; Vallabh, Tina; Phan, Hanna; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: The purpose of this study is to compare frequency of pharmacy services available in ambulatory care practice between adult and pediatric populations and to identify factors that affect the availability of such practice settings between the two populations in the United States. Methods: This study was a descriptive survey study that was distributed nationally. Participants were recruited using two electronic listservs registered with the American College of Clinical Pharmacy (ACCP), the Pediatric PRN listserv and Ambulatory Care PRN listserv. A total of 126 participants completed and submitted the electronic questionnaire. This descriptive survey study collected data through an online questionnaire distributed to adult and pediatric ambulatory care pharmacists. Descriptive variables, demographic variables, categorical variables, and ordinal data were analyzed by calculating frequencies, percentages, and averages. Main Results: The majority of participants specialize in diabetes (n = 51, 40.5%), anticoagulation (n=42, 33.3%), hypertension (n=42, 33.3%), hyperlipidemia (n=40, 31.8%), and asthma (n=32, 25.4%). Adult care was greater than pediatric care in diabetes (Adult: n=54, 42.83%; Ped: n=14, 9.53%), anticoagulation (Adult: n=46, 43.66%; Ped: n=6, 4.76%), hypertension (Adult: n=44, 34.94%; Ped: n=8, 6.34%), hyperlipidemia (Adult: n=42, 33.34%; Ped: n=3, 2.39%), and asthma (Adult: n=35, 27.78%; Ped: n=28, 22.23%). Averages of 4.88 hours of hours per week and 5.21 years of experience were obtained for provision of pediatric care in the ambulatory care setting. Conclusion: In conclusion, availability of ambulatory care services for pediatric patients is dramatically less than those available for adults. Generalized structure for location of clinics, billing for services, and funding for positions may increase the opportunity for provision of adult and pediatric ambulatory care services.
    • Evaluating the Relationship Between Diabetes and Beverage Intake by Assessing Hemoglobin A1c

      Kennedy, Amy; Kung, Diana; Patel, Dhara; Riedel, Caroline; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: The purpose of this study is to determine whether there is a correlation between diabetes control and beverage consumption. We hypothesize that diabetes control (as measured by A1C) is inversely related to consumption of sugary sweetened beverages (SSB) in patients with type 2 diabetes. Methods: This study will be a retrospective chart review evaluating the relationship between intake of sugary sweetened beverages and hemoglobin A1C values (HgA1C). Individuals will be eligible for inclusion in the study if they are current patients at El Rio Community Health Center with type 2 diabetes and were 18 years of age or older at the time of the study. Exclusion criteria are as follows: not seen by a clinical pharmacist for diabetes within the last year (Jan 2015 – Feb 2016), no beverage consumption information available in electronic chart and/or no A1C value listed in the patient’s profile. The anticipated study population will be comprised of 330 patients. The data will be analyzed using a t-test to determine the relationship between A1C and beverage consumption. Results: 150 patients were identified from the patient pool as meeting inclusion criteria. The mean fluid ounces of SSB consumption in the low SSB intake group and high SSB intake group were 7.2 (SD=2.441) and 30.269 (SD=21.197) respectively. The mean A1C in the low SSB intake group was 8.35 (SD=2.038) and in the high SSB intake group was 8.799 (SD=1.852). There was no statistically significant difference between the mean A1C in the low SSB intake group and the high SSB intake group (p=0.2451). Conclusions: The mean A1C between high SSB intake and low SSB intake appears similar.
    • Evaluation of Benzodiazepine Use in Adults at a Community Health Center

      Kennedy, Amy; Nguyen, Huong; Sanchez, Wendy; Wang, Guan; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: To describe the patterns of benzodiazepine use at a community health center in adults and to identify common demographic factors and chronic conditions that are associated with an increased usage rate. Subjects: Patients 18 years and older who had been treated at El Rio Community Health Center with an active benzodiazepine prescription on file. Methods: Data were collected from patient charts using a data collection form. Assessment included current benzodiazepine patients were taking, concurrent use of opiates and/or antispasmotics, indication for benzodiazepine use, concurrent medications for anxiety, depression, or insomnia, and prescriber type. Demographic data on age, gender, race, ethnicity, insurance type, and use of tobacco or alcohol were also collected. Results: Data were collected on 102 patients currently taking a benzodiazepine; 60 patients (mean age = 61.2, SD = 13.6) had concurrent first-line therapy for anxiety, depression, or insomnia and 42 patients (mean = 61.1, SD = 13.6) did not. There were a significantly higher proportion of women taking a benzodiazepine with first-line therapy than without first-line therapy (88.3% vs. 71.4%; p = 0.031). Additionally, higher proportion of benzodiazepine was prescribed with first-line therapy for depression than other indications (p = 0.002). Conclusions: More patients were prescribed benzodiazepines with concurrent first-line therapy for depression than other indications such as anxiety, insomnia, or other panic disorders. For this reason, health care professionals should be aware of the patterns of benzodiazepine use and comply with current recommended practice guidelines.
    • Evaluation of Extended Dual Antiplatelet Therapy with Aspirin and Clopidogrel Among Men and Women Patients at El Rio Health Center

      Kennedy, Amy; Jaeger, Alina; Pham, Kimberly; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: Analyze trends in prescribing extended dual antiplatelet therapy (DAPT) with aspirin and clopidogrel between men and women patients at El Rio community health center. Methods: Patients at a community health center who were on DAPT for longer than one year were identified through retrospective chart review. Demographic and descriptive data were recorded, including patient age, gender, indication for therapy, and type of prescriber. Based on prescribing guidelines, acute coronary syndrome (ACS) with bare-metal stent or drug-eluting stent, and drug-eluting stent without ACS were considered to be appropriate indications of extended DAPT. All other indications were considered inappropriate. Results: Data was collected for 27 men (mean age = 68; SD = 9.82; 70.4% hispanic or latino) and 31 women (mean age = 70; SD = 10.49; 83.9% hispanic or latino). Dual antiplatelet therapy was appropriately prescribed for 17 men and 20 women (63% and 64.5%, p=0.08). Conclusions: Overall, the difference in adherence to prescribing guidelines for men and women was not significant.
    • Identification and Evaluation of Courses within Pharmacy School Curricula Focusing on Health Care Disparities

      Kennedy, Amy; Dindal, Derek; Sykes, Sabrina; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: To identify and assess cultural competency courses for healthcare professionals that are available to pharmacy students. Methods: A literature review was performed to identify research articles discussing pharmacy courses in health care disparities. Additionally, a systematic review of all curricula for ACPE accredited schools of pharmacy was conducted and these syllabi were subsequently evaluated. Main Results: The search identified XXX articles focusing on specific health disparities curricula in schools of pharmacy and XXX syllabi about specific courses. Out of those articles and syllabi XXX were included in the analysis. Results are pending. Conclusions: Anticipated results will be utilized to design effective health disparities curricula at the University of Arizona College of Pharmacy.
    • Impact of Pharmacist Intervention on Knowledge of Diabetes and Among Diabetic Patients

      Kennedy, Amy; Azimian, Sara; Boysen, Amanda; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: To further explore the relationship between patient’s diabetes knowledge and pharmacist intervention in patient care related to diabetes management. Study participants included diabetic patients being seen at the El Rio Health Clinic East campus. Subjects were patients being seen only by their primary care providers for diabetes management as well as patients being managed by a clinical pharmacist in addition to their primary care provider. Methods: Questionnaires were administered to eligible patients at the time of their clinic visit. Knowledge was assessed in various areas of diabetes management including diet, exercise, blood glucose management, overall diabetes control, and insulin therapy where applicable. HbA1C was self-reported as a secondary measure. Main Results: Questionnaires were completed by a total of 78 subjects. The pharmacist group included 48 subjects (mean age = 54; SD = 11.9; 60% Caucasian; 65% female) and the non-pharmacist group included 30 subjects (mean age = 52; SD = 9.5; 66% Caucasian; 57% female). Overall, there was no statistically significant difference in diabetes knowledge (p = 0.17) between the two groups. Conclusion: Survey data from this study, although limited and not adequately powered, showed no statistically significant difference in diabetes knowledge between the pharmacist group and non-pharmacist group.
    • Inappropriate Use or Cessation of Metformin Therapy in Type 2 Diabetic Patients With Renal Impairment

      Kennedy, Amy; Lai, Yin; Vemulapalli, Beena; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: To assess appropriate use or cessation of metformin therapy in the presence of renal impairment. Methods: A retrospective chart review was conducted on 785 charts of patients at El Rio Community Health Center between June 2011 and December 2012. Eligibility criteria were adults aged 18 years or older with a diagnosis of Type 2 Diabetes Mellitus (DM), a history of metformin therapy, and renal function data. Data was accessed through the electronic medical record (EMR) at El Rio and metformin history, presence of contraindications, renal function, weight, age, gender, and race/ethnicity were collected. Group 1 were patients who were currently taking metformin and Group 2 were patients with a history of taking metformin. Main Results: A larger proportion of patients had renal impairment (eGFR 30-60 ml/min/1.73 m2) in Group 1 than Group 2 (Yates’ p = 0.002). Only one patient in the entire study had severe renal impairment (eGFR < 30 ml/min/1.73 m2). There was a greater proportion of inappropriate cessation in Group 2 than inappropriate use or cessation in Group 1 (Yates’ p < 0.001). Conclusion: Most patients were found to have normal renal function. Group 2 had a greater proportion of inappropriate metformin cessation than inappropriate use or cessation in Group 1.
    • Incidence of and Frequency of Monitoring for Hyponatremia Associated with SSRIs: a Retrospective Chart Review at One Institution

      Kennedy, Amy; Ellis, Kristen; Pavone, Stephanie; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: To describe the incidence of hyponatremia in patients using SSRIs and to assess how often health care professionals obtain electrolyte panels after SSRI initiation. Also, to identify the most recent sodium level in patients and to compare sodium levels in a patient group using an SSRI and a control group not using an SSRI. Subjects: Patients who received care at a large multi-center ambulatory care clinic between January 1st, 2008 and December 31st, 2011. Methods: An electronic medical record database was used to identify potential patients through medication records reflecting SSRI use or diagnosis of low back pain, obesity, pruritis, rash, or fibromyalgia. The following data was collected: patient gender, age, weight, height, use/non-use of SSRI, plasma sodium level, and documented past hyponatremia diagnosis. Plasma sodium levels and hyponatremia incidence were compared from the SSRI group to the non-SSRI group. In addition, the SSRI group was analyzed for incidence of documented hyponatremia. Monitoring of sodium levels after SSRI initiation was also investigated. Main Results: Overall, 500 charts were reviewed. After inclusion and exclusion criteria were applied, 118 patients were included in the study (38 in the SSRI group, 80 in the control group). The incidence of hyponatremia in the SSRI group and control group was 2.63% and 1.25% respectively. There was no significant difference between groups (p=0.542). Sodium levels were monitored 19.2% of the time after SSRI initiation. Conclusion: The incidence of hyponatremia was similar between groups. Physicians are not adequately monitoring for hyponatremia after SSRI initiation.
    • Inpatient Pharmacist Intervention Helps Sustain Improved Rates of Baseline Metabolic Monitoring for Patients Initiated on Atypical Antipsychotics

      Goldstone, Lisa; Kennedy, Amy; Butler, Phalyn; Goldie, Christa; Simonson, Caitlin; Goldstone, Lisa; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: The purpose of this study is to assess whether baseline rates of metabolic monitoring of scheduled atypical antipsychotics are sustained as a result of a pharmacist intervention. Methods: This study was a retrospective chart review assessing rates of metabolic monitoring two months after a pharmacist intervention that utilized a pharmacist-physician metabolic monitoring recommendation form was discontinued. Patients ages 18 years or older with orders for a scheduled atypical antipsychotic were included. Patients with orders for first-generation antipsychotics or who have orders for as needed atypical antipsychotics were excluded. Main Results: Data from the two month post intervention period was compared to those obtained during the pharmacist intervention. For the monitoring of hemoglobin A1c and fasting lipid panels, which improved during the pharmacist intervention, there was a non-statistically significant trend towards decreased monitoring. For hemoglobin A1c, the rates of monitoring decreased from 21.59% to 12.32% (p = 0.09). For fasting lipid panels, monitoring decreased from 39.77% to 28.99% (p = 0.125). Conclusion: A pharmacist intervention utilizing a recommendation form was effective in sustaining the improvement of baseline metabolic monitoring of personal history of diabetes and cardiovascular disease and monitoring of hemoglobin A1c and lipid panels. However, a trend towards decreased monitoring was observed in both the percentage of hemoglobin A1c and lipid panels ordered. Thus, continuing pharmacist intervention may be necessary in order to ensure that baseline metabolic monitoring for atypical antipsychotics occurs.
    • The Prevalence of Metabolic Syndrome in Patients Treated with Atypical Antipsychotics in an Outpatient Health Clinic

      Goldstone, Lisa; Kennedy, Amy; Deeren, Thomas; Kent, Tanya; Sanzenbacher, Robert; Goldstone, Lisa; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: To determine the prevalence of metabolic syndrome (MetS) in patients treated in an outpatient clinic that were taking atypical antipsychotics. Methods: This retrospective chart review included 822 adults diagnosed with various personality/mood disorders. Age, gender, ethnicity, blood pressure, height, weight, lipid panels, fasting blood glucose, and second-generation antipsychotic (SGA) used and treatment length were obtained. Patients were separated into two groups: those who were not taking an SGA in/for the past three months (group 1), and those taking at least one SGA for a minimum of three months (group 2). MetS was determined using NCEP ATP III guidelines. The primary outcome measured was the difference in the prevalence of MetS between each group. Main Results: At baseline, 753 patients were in group 1 and 69 patients were in group 2, there was a higher percentage of females in group 1 (p<0.0001), and a higher percentage of males in group 2 (p<0.0001). No difference was seen with age, and weight, (p=0.294, p=0.625, respectively). There were more patients reported as Caucasian in group 2 (p=0.0001) and more reported as Caucasian/Hispanic in group 1 (p=0.0001). The rate of MetS between group 1 (54.45%) and group 2 (59.42%) was not statistically different (p = 0.427). Conclusion: No statistical difference was found in the rate of MetS between the two groups. Removing confounding drugs known to cause weight gain did not change these results.
    • Safety and Efficacy of Commercially Available Pre-Workout Supplements

      Kennedy, Amy; Dudley, Steven; Hudson, Eric; Kennedy, Amy; College of Pharmacy, The University of Arizona (The University of Arizona., 2015)
      Objectives: The purpose of this review was to determine the safety of various pre-workout supplements that utilize proprietary blends in comparison with some of the most common individual ingredients; caffeine, creatine, and B-alanine. We hypothesized that there will be a greater number of adverse events reported for proprietary products than for the individual active ingredients. Additionally, we also wanted to look at the efficacy of the same aforementioned products. We hypothesized that there would be no statistically significant differences in performance between the two arms. Methods: Four databases were searched for subjects that were 18-35 years of age that were already physically active. The number of participants included in each trial ranged from 6 to 98. Results: Caffeine was the only individual compound that affected health markers, increasing mean arterial pressure (MAP) (P<0.05), and HR in 2 of the 3 studies (P<0.05) significantly. Both caffeine and creatine showed a benefit in maximal exertion, but only caffeine improved endurance at doses of 3mg/kg (P<0.05). Proprietary blends did not show a benefit, but serious adverse events such as liver failure were reported. Conclusions: Individually caffeine, creatine, and B-alanine all look to be safe at the recommended doses in healthy and active individuals, with caffeine and creatine benefitting performance. Pre-workout blends should be safe in theory, but due to the unregulated nature of the supplement industry there are a number of serious adverse events that occur. Untested amphetamine-like compounds seem to be the most common addition, with contamination of other ingredients such as anti-depressants occurring as well.