• Cost Effectiveness Analysis of Empiric Skin and Soft Tissue Infections Requiring Hospitalization and Methicillin Resistant Staphylococcus Aureus Coverage

      Malone, Daniel; Kennedy, William; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess the cost-effectiveness of vancomycin, daptomycin, linezolid, oritavancin, and telavancin as empiric treatment for MRSA skin and soft tissue infections in an inpatient setting from a third party perspective. Methods: A decision analytic tree model was constructed using TreeAge Pro and utilizing efficacy data from published clinical trials and costs estimates using HCUPnet.gov and Micromedex’s RedBook. Sensitivity analyses were run on linezolid costs, as well as oritavancin’s costs and efficacy data. Results: Linezolid was the most cost effective medication, dominating all other therapies. In a sensitivity analysis, increasing linezolid’s cost to include 7 days of inpatient therapy did not result in other therapies no longer being dominated. In two other sensitivity analyses, oritavancin was no longer dominated at 91.8% efficacy, but was still dominated with only 3 days of inpatient therapy. Conclusions: Linezolid was the most cost effective therapy for empiric treatment of suspected MRSA skin and soft tissue infections requiring hospitalization from a third party perspective.
    • In vitro aerodynamic analysis of co-spray dried fluticasone propionate (FP) and salmeterol xinafoate (SX) dry powder inhalation aerosols with lactose-alternative excipient

      Mansour, Heidi M.; Malapit, Monica; Mallory, Evan; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Milk protein allergy is estimated to affect 1.2% to as much as 17% of people of all ages. Advair® Diskus® (FP/SX) utilizes lactose as an excipient which limits the utility of this product for this population. Furthermore, Advair® Diskus® is formulated as an interactive physical mixture via a micronization process. Alternatively, spray dried engineering achieves narrow particle size distribution, allowing greater deposition in the targeted respiratory bronchioles. The purpose of this dry powder inhaler (DPI) study was to conduct an in vitro comparative analysis of the aerodynamic performance of a co-spray dried lactose-free formulation of FP/SX with a mannitol excipient as a molecular mixture versus the Advair® Diskus® 250/50 (FP/SX) interactive physical mixture product. Methods: Utilizing mannitol as an excipient, a co-spray dried FP/SX powder was prepared using the Buchi Mini-Spray Dryer B-290 under closed system configuration. The resulting feed solution was spray dried at pump rates of 25%, 50%, and 100% with all other parameters remaining constant (aspiration, atomization rate, nitrogen gas rate). The primary outcome measure, aerodynamic performance, was assessed using the Copley Next-Generation Impactor (NGI). NGI data for the DPIs was used to calculate mass median aerodynamic diameter (MMAD), geometric standard deviation (GSD), and fine particle fraction (FPF) of each powder, including the Advair® Diskus®. Residual water content was quantified by Karl Fischer titration. Particle characteristics were visualized by scanning electron microscopy. Results: FPF, MMAD, and GSD were calculated from NGI data; Wolfram Alpha software was used to calculate MMAD and GSD. T-test regression was used for comparative analysis of spray-dried and Advair® Diskus® powders. MMAD for each spray dried sample was analyzed using a t-test regression against the MMAD values from the Advair® Diskus®. Using aerodynamic analysis studies triplicated for each powder, there was no significant difference between the spray dried powder and Advair® Diskus® for MMAD and GSD (p-values >0.05). The 50% and 100% pump rate samples had similar FPF to the Advair® Diskus® (p-values >0.05). However, the 25% pump rate sample had a significantly improved FPF compared to the Advair® Diskus® (p <0.01). Conclusions: A co-spray-dried lactose-free formulation of FP/SX with a mannitol excipient demonstrated similar aerodynamic performance to the Advair® Diskus® which consists of a physical mixture of two drugs with lactose. Of significance, 25% pump rate spray-dry conditions demonstrated an improved FPF compared to the Advair® Diskus®.
    • Evaluation of Safety and Efficacy Outcomes from use of Extended Infusion of Beta-Lactam in the treatment of Acute Pulmonary Exacerbations in Cystic Fibrosis

      Matthias, Kathryn; Tien, Quang; Sivinski, Jared; Lew, Darren; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The objective of this retrospective cohort chart review was to evaluate the safety and efficacy of extended infusion beta-lactam regimens as part of treatment of acute CF pulmonary exacerbations in adults and pediatric patients. Methods: Inclusion criteria: adult and pediatric patients (age 1 month or older) with CF diagnosis who were admitted to BUMC-T for acute pulmonary CF exacerbation, and who received meropenem, imipenem, aztreonam, piperacillin-tazobactam, and or cefepime during their hospitalization (between 1/1/2011 and 10/30/2015). Exclusion criteria: pregnant women and admissions less than 24 hours. The two groups evaluated were patients receiving treatment (group 1) prior to extend infusion practices (Jan 2011 – Dec 2012) and (group 2) after implementation of extend infusion practices (Jan 2013 – Oct 2015). Data was collected from medical records using both the Sunrise Clinical Manager and EPIC electronic medical record systems. The data was then analyzed for differences in efficacy outcomes (e.g., length of hospitalization, lung function, return to baseline lung function), changes in renal and hepatic function, incidence of documented adverse drug effects, and potential factors associated with increased risk for changes in renal or hepatic function with use of extended infusion beta‐lactam regimens. Results: Pending. Efficacy outcomes: - length of hospitalization - improvement in lung function - return to baseline lung function Safety outcomes: - changes in renal and hepatic function - incidence of documented adverse drug effects - potential factors associated with increased risk for changes in renal or hepatic function Conclusions: Pending. As this study is being conducted at one academic medical center, conclusions may not be generalizable to other institutions.
    • Evaluation of a Specialty Pharmacy Counseling Program on Patient Outcomes for Oral Oncolytic Medications

      Mathews, Kelly; Voight, Michael; Ketterer, James; Kennedy, Kyle; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Our working hypothesis is that patients who opt in to pharmacist counseling will have a higher medication possession ratio and longer length on therapy than patients who opt out of pharmacist counseling. Methods: Using data extracted from patient’s charts we retrospectively calculated medication possession ratio and length on therapy in relation to the patient receiving or not receiving counseling. Results: The patients analyzed were receiving 8 specific oral oncolytic medications provided by Avella Specialty Pharmacy in 2015. There were no significant differences found in MPR values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.826), Lonsurf (p=0.392), Stivarga (p=0.838), Zydelig (p=0.633), Zykadia (p=0.077), Tagrisso (p=0.060), Imbruvica (p=0.263) and Tarceva (p=0.326). No statistically significant differences were found in LOT values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.885), Lonsurf (p=0.868), Stivarga (p=0.326), Zydelig (p=0.502), Zykadia (p=0.212), Tagrisso (p=0.089), Imbruvica (p=0.540), Tarceva (p=0.129). Conclusions: Pharmacist counseling does not appear to affect MPR or LOT for patients taking oral oncolytic medications. Further research is warranted targeting other chronic disease states with complex oral regimens where medication adherence has not already been established from prior therapy options and adequate disease state knowledge.
    • Cost-Effectiveness Analysis of PCSK9 Inhibitors for the Treatment of Heterozygous Familial Hypercholesterolemia

      Malone, Daniel; Lasica, Rick; Loy, Ashley; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To determine the cost-effectiveness of proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors with high-intensity statins compared to high-intensity statins alone for the treatment of heterozygous familial hypercholesterolemia (HeFH). Methods: A Markov model was built through TreeAge Pro to model two groups: patients taking PCSK9 inhibitors with high-intensity statins or high-intensity statins alone. For each group, there were five health states that patients could be in: well, unstable angina, myocardial infarction, ischemic stroke, or death. The data used in the model were extracted from published clinical trials evaluating PCSK9 inhibitors and statins. Results: For the primary analysis, the overall cost and effectiveness was $31,390.93 and 23.01 for the statin alone group and $362,798.50 and 24.32 for the PCSK9 with statin group, respectively. The incremental cost, incremental QALY, and incremental cost-effectiveness ratio (ICER) was $331,407.60, 1.31 QALYs, and $252,833.60/QALY, respectively. Conclusions: Since the calculated ICER was higher than the pre-established threshold of $150,000, the results from our primary analysis suggest that treatment of patients with HeFH with a PCSK9 inhibitor and a high-intensity statin is not cost effective, compared to treatment with a high-intensity statin alone. However, when certain parameters (cost of PSCK9 and mortality rate) were adjusted in the secondary analyses, these agents appear to be cost-effective.
    • 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.
    • Identifying types of Motivation in Type 1 Diabetes Self-Management and Exercise in Adolescents

      Bhattacharjee, Sandipan; Kwan, Jason; Nguy, Linda; Yang, Jingxin; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The purpose of the study was to identify the types of motivation that promote sustained physical activity among adolescents between the ages of 11-17 who are diagnosed with type 1 diabetes (T1D) to prevent diabetes related complications. Methods: Questionnaires were distributed and collected among the Juvenile Diabetes Research Foundation’s (JDRF) listserv, Facebook page, and events in Phoenix and Tucson, Arizona on motivations for managing diabetes and exercise and confidence in diabetes management and performing physical activity. Demographic data was collected on age, gender, and race/ethnicity. Physical activity, levels of activity intensity, weight, height, health- related risk behaviors, chronic health conditions, and use of preventative services were also included in this study. Results: 11 adolescents completed questionnaires, categorized by participants who exercise less than 60 minutes daily (Group below recommended exercise level, GBRE) and participants who exercise more or equal to 60 minutes daily (Group meeting recommended exercise level, GMRE). GBRE’s average mean age was 15.75 and GMRE’s average mean age was 13.92. GMRE was associated with higher intensity physical activity (42.85% versus 0%). GBRE had a relative autonomy index (RAI) of 1.67 on the Treatment Self-regulation Questionnaire (TSRQ) compared to GMRE with a RAI of 3.81 (Mann-Whitney U 19, p-value 0.412). GBRE scored 73.75 on the Diabetes Self-efficacy Scale (DSES) and GMRE scored 78.71 (Mann-Whitney U 7, p-value 0.23). Conclusions: Adolescents who exercised ≥ 60 minutes daily were observed to be self-motivated in managing their diabetes, especially maintaining exercise recommendations to decrease diabetes related complications.
    • Curriculum Map of the University of Arizona College of Pharmacy

      Cooley, Janet; Tran, Thuyvi; Nguyen, Quang; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To describe the content of the currently enacted curriculum and confirm that the University of Arizona doctor of pharmacy degree program meets all required elements defined by the Accreditation Council for Pharmacy Education (ACPE) appendix 1. Methods: A curriculum map that lists courses taken by each class years and the 2016 ACPE appendix 1 elements was developed. Course syllabi were then evaluated for class sessions that fit within specific ACPE required elements. Each 50 minutes class session was classified as a lecture unit (lu) and the total number of lu were recorded on the map. Furthermore, the redundancy of categorized sciences (biochemical, pharmaceutical, social/administrative/behavioral sciences) were evaluated with the map. Lastly, diabetes contents taught within each course and corresponding assessment tools were collected to gauge opportunities for progression of knowledge. This was done by confirming that different factors of the disease were taught within different courses. Results: Each required ACPE element was covered by at least one lu within the curriculum. The 1st, 2nd, and 3rd year covered 67.5%, 54.1%, and 40.5% of ACPE required elements, respectively. The subject of diabetes was covered with 24 lu, 4 lu, and 14 lu within the 1st, 2nd, and 3rd years, respectively. Progression of knowledge in diabetes was seen in the course materials. Conclusions: The enacted curriculum covers all ACPE required contents. The 1st year of the program teaches the largest percentage of required elements. All categorized sciences were reemphasized and the opportunity for progression of knowledge was shown.
    • 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.
    • Prescription Stimulant Medication Attitudes and Beliefs of Undergraduate Students Involved in Social Sororities

      Goldstone, Lisa W.; Ong, Nicholas; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To first educate undergraduates involved in social sororities about prescription stimulant medications and to evaluate the effectiveness of an educational intervention in influencing the attitudes and beliefs regarding prescription stimulant medication use of undergraduates involved in a social sorority. Methods: The intervention, an educational session, was presented to undergraduates involved in social sororities. Questionnaire that included demographic data of gender, age, ethnicity, race, undergraduate year, grade point average, type of member, history of an attention-deficit/hyperactivity disorder (ADHD) diagnosis, and previous or current non-medical use of prescription stimulants were collected. The participants’ beliefs on nine statements regarding prescription stimulants were queried pre- and post-intervention using a four-point Likert scale ranging from strongly disagree to strongly agree. To analyze change in attitudes and beliefs, Mann-Whitney test was used. Results: One hundred sixty-three sorority members participated in the study. The average age of participants was 19 years with the majority of respondents identifying as an active sorority member (81%) and in their first year of undergraduate study (69%). There was a statistically significant change in beliefs regarding the safety (p < 0.01) and health risks (p = 0.02) associated with prescription stimulants. There was no significant difference in topics relating to addiction, legality, emotional and academic outcomes from the use of prescription stimulants. Conclusions: The education session was effective in changing participants’ beliefs on safety and health risks of nonmedical use of prescription stimulants.
    • The Effects of Using the RxTimerCap© on Patient Medication Adherence

      Matthews, Kelly; Lawler, Lauren; Slack, Marion; Navoa, Gabriel; Eljerdi, Osama; Huo, Ye; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Medication adherence tools and technologies can have a significant impact on the level of drug therapy continuation as well as improved outcomes. The RxTimerCap© is a device that aims to act as a medication adherence cap with an embedded timer to indicate the time since the medication was last taken. Our aim was to assess if this cap technology would aid in increased drug adherence and duration of therapy with abiraterone (Zytiga®). Methods: The study was a prospective, single-center, interventional study that included males 18 or older being treated with Zytiga for castration-resistant metastatic prostate cancer. Medication possession ratio (MPR) and duration on therapy were the primary measures used to assess if there would be improved adherence. Paired t- tests were used to analyze the data and assess the significance of the outcomes. Results: There was no significant difference between patients in MPR (p = 0.50) or in the duration of treatment (p = 0.20). Conclusions: The difference in adherence rates for patients using the RxTimerCap© and those using the standard vial cap were non-significant. The limited size of our study population and short study duration may have led to these undifferentiated outcomes. Future studies should examine this type of adherence technology in a larger sample of patients with a prolonged window of observation to better assess the benefits of using the RxTimerCap©.
    • Benefits and Sources of Calcium & Vitamin D: A Cross-Sectional Questionnaire Assessing Patient Knowledge and Contributing Factors

      Spencer, Jenene; Cooley, Janet; Browne, Jessica; Lunt, Nathan; Zappia, Julie; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess the general public’s knowledge of the benefits and sources of calcium and vitamin D dietary and supplemental intake and to identify any pertinent demographic characteristics that influence such knowledge. Methods: Participants were convenience sampled from Walmart locations in Safford, Arizona and Tucson, Arizona. Each participant completed a brief survey assessing their knowledge about the benefits and sources of calcium and vitamin D and optional questions regarding demographics. Results: 51 participants in Safford and 51 participants in Tucson completed the questionnaire. Of the 51 responders in Safford, 18 were men and 24 were women with a mean age of 49.52 (SD = 14.53, 80.49% white). Of the 51 responders in Tucson, 22 were men and 17 were women with a mean age of 50.97 (SD = 17.32, 71.79% white). Baseline demographics were equivalent. Statistical significant was observed when the mean total scores from Tucson and Safford were compared. On average, the participants in Tucson scored higher when compared to participants in Safford with mean scores of 55.5% and 49.0% respectively (p= 0.0412). Conclusions: Tucson participants scored statistically significantly higher when compared to Safford participants. This may be due to the health disparity between urban and rural populations. Gender, ethnicity, supplement use, personal or family history of osteoporosis, and education level did not appear to affect response scores on the questionnaire.
    • 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.
    • Comparing the Efficiency and Accuracy of Health Information Exchange (HIE) to the Traditional Process of Medication Reconciliation during Admission at the Pima County Adult Detention Center (PCADC)

      Warholak, Terri; Gupta, Vidhi; Weber, Rebecca; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess the change in efficiency and accuracy of the medication reconciliation process at the Pima County Adult Detention Center (PCADC) after implementation of a Health Information Exchange (HIE) and also to identify the percentage of patients whose medication data is available in the HIE Methods: This program evaluation was a retrospective comparison of the traditional self-reported method of medication reconciliation to the HIE method. It compared the number and types of medication discovered for each patient using the traditional medication reconciliation collection data (the self-reported method) and the new database query method (HIE method) Results: 200 samples were randomly selected (100 random detainees and 100 with known medical record in the HIE database) to participate in the study. A total of 150 patients (61%) were retrieved from the HIE database, of which 100 were from the control group and 50 from the random group. The total numbers of medications that these 150 patients contributed was 284. Mean completeness of self-reported medications was 54% while HIE yielded an average of 99% (χ2; p<0.0001). 9 patients (4%) had both self-reported medications and medications within the HIE database in which 17 medications (62%) compared to the self-reporting method with 14 medications (52%) sharing the same name. There were no medication dose matches between self-reported medications and HIE queried medications. Conclusions: The addition of an HIE database to the existing self-reporting process of collecting a detainee’s medication reconciliation provides a more comprehensive and accurate medical record
    • Assessment of the General Knowledge of Prescription and Over-The-Counter (OTC) Pain Medications in Older Adults

      Lee, Jeannie; Flath, Ali; Hwang, Mandy; Nguyen, Yen; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess older adults’ knowledge of prescription pain and over-the-counter (OTC) medications, to determine if age influences older adults’ choice of OTC pain agents, and to determine if education by a pharmacist about prescription and OTC pain medications impacts the score on a medication knowledge indicator. Methods: This is a descriptive survey study. Participants received a recruitment email with a consent link in order to participate in the secure, online Qualtrics survey. The survey consists of 10 knowledge-based items on pain medications and 12 demographic items. The primary outcome of this study is the knowledge about pain medications of adult 75 years and older. Knowledge scores were analyzed using a Chi square test to compare the proportion of respondents in each age group who score 50% or more. The secondary outcome is the purchase pattern of OTC pain medications based on age. OTC purchasing data was analyzed using a nonparametric regression test. The tertiary outcome is the effect of pharmacist counseling on patients knowledge of prescription and OTC medications. The knowledge indicator scores were compared in patients who reported as either being educated by a pharmacist or not using a one-way ANOVA test. Results: The questionnaire was completed by a total of 50 people, but three were excluded due to not meeting the age requirement of 50 years and older. Forty-seven participants were used in the analysis with mean age of 68.3 years (range 55 to 90) and 72% female. Of 44 participants who completed the entire survey those 75 years and older scored better on the knowledge indicator (71% scored ≥50%) compared with those 74 years and younger (54% scored ≥50%); however, no significant difference was found (p = 0.28). In addition, purchasing pattern based on percentage of both prescription and OTC medications between both groups appeared to be insignificantly different (p = 0.31 and 0.51 respectively). The mean number of OTC medications purchased equaled the mean number of OTC medications purchased for adults less than 75 years of age (Y = 1.2 vs. 1.2 medications per patient, p=0.51). Finally, all patients age 75 and older that reported being educated by a pharmacist scored 50% or greater on the knowledge indicator (100%) while 52% of participants 74 years and younger scored 50% or greater (p = 0.673). Conclusions: Adults ages 75 years and older possess the same basic knowledge of pain medications when compared to adults age 50 to 74. In addition, adults age 75 years and older purchase over-the-counter (OTC) at the same rate as adults age 50 to 74. Finally, adults age 75 years and older benefit most from pharmacist consultation compared to adults age 50 to 74.
    • Comparison of Enoxaparin Versus Aspirin for Thromboprophylaxis in Veterans Affairs (VA) Hospital Patients after a Total Knee Arthroplasty (TKA) or Total Hip Arthroplasty (THA)

      Merchen, Jon; Cooley, Janet; Fung, Sierra; Jankowski, Mika; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The first aim is to assess efficacy of aspirin versus enoxaparin in preventing a venous thromboembolism (VTE) after a total knee arthroplasty (TKA) or total hip arthroplasty (THA) within 30 days after discharge. The second aim is to assess the safety of aspirin versus enoxaparin in preventing major bleeding events after a TKA or THA within 30 days after discharge. Methods: This study was a retrospective cohort study with data obtained from an online Veterans Affairs (VA) hospital database. For analysis, the primary outcome was assessed with a Chi-Square test, and the secondary outcome was reported with descriptive statistics.Results: Results: Demographics for 374 patients (TKA, n = 275; THA, n = 99): 90% male, average age of 65, average body mass index (BMI) of 32, 26% smokers, 72% had a history of hypertension, and 60% had a history of dyslipidemia. VTE events 30 days post-operatively: enoxaparin (n = 2), enoxaparin/aspirin (n = 1), and aspirin (n = 2) (P-value = 0.78). Safety events (major bleeding events): enoxaparin (n = 42), enoxaparin/aspirin (n = 7), and aspirin (n = 4). Conclusions: There was no significant difference between the treatment groups for VTE rate 30 days post- operation. The enoxaparin treatment group had the greatest number of safety events compared to the other groups.
    • Patient Satisfaction and Utilization of Pharmacy Care Services at an Independent Community Pharmacy

      Trepanier, Marla; Warholak, Terri; Dooda, Nicole; Leonard, Alexander; Nguyen, Kim; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To determine if there is a correlation between both awareness and utilization of pharmacy care services and patient satisfaction at an independent community pharmacy in Benson, Arizona. Subjects: Patients who visited the pharmacy within a 45-day period in 2016 and who have filled at least one prescription at that location. Methods: A self-reported questionnaire was administered by pharmacy staff to assess patients’ satisfaction ratings on the pharmacy’s performance. The questionnaire also inquired about patients’ awareness and use of pharmacy services as well as demographic information including a history of specific disease states. Data were evaluated using analytic software. Results: Questionnaires were completed by 48 men (mean age = 65.8; SD = 12.57) and 69 women (mean age 60.3; SD = 15.06), with the mean number of select health conditions being 1.63 (SD = 1.16) and 1.49 (SD = 1.24), respectively. There was no correlation between the number of services for which a patient was aware, nor the number of services utilized, and overall satisfaction (p=0.466 and p=0.384, respectively). However, there was a significant positive correlation between awareness and utilization of pharmacy services (r=0.208, p=0.019). Over 74% of respondents rated satisfaction for all measures “excellent,” with professionalism of the pharmacist (92.1%) and pharmacy staff (89.9%) ranking highest. The only category that received a “poor” rating was how well the pharmacist explains medication side effects. Conclusions There was no apparent correlation between awareness of pharmacy care services and patient satisfaction at The Medicine Shoppe in Benson, nor between utilization of pharmacy services and satisfaction. However, patient satisfaction scored high in all categories surveyed.
    • Identifying the Types and Frequencies of Medication Dispensing Errors in Community Pharmacies and their Potential Causation

      Squire, Robert; Felix, Francisco; Mesa, Nathaniel; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To explore the available literature for information on the types of medication errors committed in community pharmacies, the rate of occurrence, and potential causation of those errors. Methods: A literature search was conducted in PubMed for articles dating from 1995-present concerning medication errors committed in community pharmacies. A total of eight studies were used in the evaluation. Results: Error types identified in the literature include content errors, labeling errors, near errors, clinically significant errors, and any other deviation from the prescriber's original order. Each study had its own individual error rate. Combining all studies reviewed, the overall average error rate was 2.2% (516 errors out of 23,455 prescriptions total). Proposed causation of medication dispensing errors include low lighting levels, high sound levels, the use of manual prescription inspection alone, pharmacy design, problems with efficiency, the use of drive through pick up windows, errors in communication, high prescription volume, high pharmacist workload, inadequate pharmacy staffing, and the use of dispensing software programs that provide alerts and clinical information. Conclusions: The available literature proposes that medication-dispensing errors in community pharmacies continue to be a frequent issue. Error types include content, labeling, clinically significant, near errors, and any other deviation from the prescriber's original order. Of the observed errors, labeling was most frequent. The data indicated low lighting, amplified noise, and sociotechnical factors could contribute to error frequency. Future studies are required to focus on other potential causes of dispensing errors and how to minimize rate of occurrence.
    • Awareness of Medication-Related Fall Risk Before and After Online Education

      Lee, Jeannie; Ancheschi, Evellyn; Henry, Nicole; Votruba, Cassandra; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The aim of this project was to assess community-dwelling older adults’ knowledge of prescription and Over-the-Counter (OTC) medications associated with fall risk, then provide an online educational intervention tailored to older adults on the topics they answer incorrectly. The knowledge assessment of the missed questions will be repeated after the online education to detect the effectiveness of the online intervention in increasing the knowledge of community-dwelling older adults. Methods: This study used an interventional design with pre-test, post-test survey method to quantitatively analyze community-dwelling older adults’ knowledge on medication-related fall risk. The persons taking the survey were community dwelling older adults, 65 years of age and older, living in the greater Tucson and Phoenix areas. Data was obtained through an online Qualtrics questionnaire between February 1, 2016 and February 1, 2017. The survey respondents answered questions regarding prescription and OTC medications associated with fall risk. For the questions they answered incorrectly, an online educational intervention tailored to older adults was provided immediately. The knowledge assessment of the missed questions was repeated after the online education to detect the effectiveness of the intervention. Results: Questionnaires were completed by 302 community-dwelling older adults. The mean age of the participants was 79 (range 65 to > 96), and majority were women (61.2%). A majority of respondents (53.87%) reported falling once in the last 5 years. Of the total participants, 50% were taking between 5 and 9 prescribed medications and 56% taking 0 to 4 OTC medications. The primary outcome of this study is that online education was effective in educating community dwelling older adults on medication-related fall risk. Patients whose pharmacist had previously educated them did not directly correlate with better performance on the pretest than those who did not receive counseling. Participants that received online education during the survey improved their score from 69% before education to 84% post education. Conclusions: The online educational intervention on medication-related fall among older adults was effective and informative. Such educational strategy may be used by pharmacists to educate older patients using medications that may increase fall risks.
    • In Vitro Evaluation of Thymoquinone and Thymol Inhibitory Activities Against Alpha-Glucosidase

      Nix, David; Maher, Noureddine; Begijian, Argam; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Evaluate thymoquinone (TQ) and thymol (THY) inhibitory activities against α-glucosidase enzyme by using an in vitro assay and determine the IC50 (concentration of TQ/THY to inhibit 50% of maximum enzyme activity). Methods: Various concentrations of thymoquinone and thymol were incubated, separately, with one concentration of the substrate - p-nitrophenol-α-D-glucopyranoside (PNPG) (<